Peer Review #3 of "Association between coronary artery disease and incident cancer risk: a systematic review and meta-analysis of cohort studies (v0.1)"

Objective: Coronary artery disease (CAD) and cancer are the two leading causes of death worldwide.Evidence suggests the existence of shared mechanisms for these two diseases.We aimed to conduct a systematic review and meta-analysis to investigateassociation between CAD and incident cancer risk. Methods:We searched Cochrane, PubMed, and Embase from inception until October 20, 2021, withoutlanguage restrictions.Observational cohort studies were used to investigate the association between CAD and incident cancer risk.Using random-effects models, the odds ratio (OR) and 95% confidence interval (CI) were calculated.We utilized subgroup and sensitivity analyses to determine the potential sources of heterogeneity and explore the association between CAD and specific cancers.This study was conducted under a pre-established, registered protocol on PROSPERO (CRD42022302507). Results:We initially examined 8,533 articles, and included 14 cohort studies in our review, 11 of which were eligible for meta-analysis.Patients with CAD had significantly higher odds of cancer risk than those without CAD (OR = 1.15, 95% CI = [1.08,1.22],I 2 = 66%).Subgroup analysis revealed that the incident cancer risk was significantly higher in both sexes and patients with CAD with or without myocardial infarction.Sensitivity analysis revealed that the risk remained higher in patients with CAD even after >1 year of follow-up (OR = 1.23, 95% CI = [1.08,1.39],I 2 = 76%).Regarding the specific outcome, the incident risk for colorectal and lung cancers was significantly higher (OR = 1.06, 95% CI = [1.03,1.10],I 2 = 10%, and OR = 1.36, 95% CI = [1.15,1.60],I 2 = 90%, respectively) and that for breast cancer was lower (OR = 0.86, 95% CI = [0.77,0.97], I 2 = 57%) in patients with CAD than in those without CAD. Conclusion:CAD may be associated with incident cancer risk, particularly for lung and colorectal cancers, in men and women as well as patients with or without myocardial infarction.Early detection of new-onset cancer and detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality.