The Possible Risk of Cancer in Claudicants

Abstract

The aim of this study was to select a group of patients who had mild intermittent claudication and were undergoing secondary prevention measures, and record all vascular and non-vascular events over a 10-year follow-up. A total of 534 events were recorded in 109 claudicants. 25.7% of the claudicants died, 39% of them due to vascular events, 36% from cancer and 25% from other causes. 17 of the 20 cancer cases could be classified as related to smoking. Cancer occurred relatively early in the study, within the first five years, while severe vascular events occurred mainly during later periods. A clear transformation occurred in the outcome of the claudicants. Mortality was equally attributable to vascular and cancer-related comorbidities. In conclusion, the improvement of vascular outcomes due to secondary prevention measures and technological advances in the management of acute vascular events may result in a relative increase in cancer incidence and deaths.

The Fate of Patients with Intermittent Claudication in the 21st Century Revisited – Results from the CAVASIC Study

“…The extended life time on the other hand carries the risk of cancer development which then accounts for the majority of deaths. A variety of studies investigated cancer mortality among PAD patients [23][24][25] . Fiotti et al examined 223 patients with intermittent claudication and 446 control subjects between 1974 and 1998.…”

Cancer Risk and Subsequent Survival after Hospitalization for Intermittent Claudication

“…Prior studies linking coronary heart disease and cerebrovascular disease to cancer risk point to an association primarily with smoking-related cancers, with inconsistent findings regarding a few nonsmoking-related cancers (6)(7)(8)(9)(10)(11). Previous research regarding the relation of intermittent claudication with risk of cancer is limited to one population-based cohort study from Sweden (9).…”

“…Intermittent claudication shares an atherosclerotic pathology with myocardial infarction and cerebrovascular disease, both of which have been shown to be associated with an increased risk of cancer (4)(5)(6)(7)(8)(9)(10). Myocardial infarction and cerebrovascular disease are strongly associated with cigarette smoking, which is also associated with cancer risk (9)(10)(11).…”

“…Consequently, one explanation for the cancer associations of these vascular diseases is the shared risk factor of smoking. Indeed, the excess cancer risk in individuals with myocardial infarction and cerebrovascular disease is largely limited to smoking-related cancers (4)(5)(6)(7)(8)(9)(10). An association between intermittent claudication and cancer risk has been shown in multiple studies, but with inconclusive results regarding whether the increased risk is limited to smoking-related malignancies (9)(10)(11).…”

“…Paraneoplastic hypercoagulability from an occult tumor may precipitate intermittent claudication, which may then be a symptom of an occult malignancy (6). Shared risk factors other than smoking, such as obesity, high intake of dietary fat, low physical activity, metabolic syndrome, or type II diabetes may contribute to a long-term positive association between intermittent claudication and cancer (8). Finally, increased medical attention after a new diagnosis of intermittent claudication may result in the detection of asymptomatic cancers.…”