Cancer as a novel risk factor for major cardiovascular adverse events in secondary prevention

Introduction: The inflammatory mechanisms of cancer can be associated with atherosclerosis development and progression. Although the incidence of events in secondary prevention following a first acute coronary syndrome is poorly documented. Methods: A retrospective cohort study including patients who underwent a coronary angiography for first Acute Coronary Syndrome (ACS), and without prior history of Major Cardiovascular Events (MACE) from 2008 to 2023 was analyzed. Included patients were grouped according to the absence or presence of cancer: G1 non-oncologic, and G2 oncologic (either prior or current history). We compared the incidence rate ratio of MACE within 3 years after ACS between groups Time-to-event analysis was conducted through proportional Cox regression analysis, estimating hazard ratio, and corresponding 95 % confidence intervals (95 % CI). Results: Of 937 patients who underwent a coronary angiography, 787 patients were included, of which 88.7 % (n = 698) presented without cancer. Over a median follow-up time of 48 months IQR = 14-72, the incidence rate of MACE was 4.4 cases per 1000 patients/months of follow-up (n = 173 MACE events). When comparing both groups, the incidence rate ratio of MACE was 1.9 (95 % CI 1.24-2.99), significantly increased in the cancer group (P = 0.0032). Cancer was an independent predictor of MACE after adjustment for traditional cardiovascular risk factors (HR 1.84, 95 % CI 1.19-2.85; P = 0.006). Conclusions: Patients with cancer represent a novel independent risk factor for MACE, even following secondary preventive therapies. These results highlight future endpoints for cardiovascular prevention and further public health interventions in this population.