Key result
Cancer patients had a significantly higher prevalence of extensive coronary artery calcium scores (>400) compared to matched non-cancer patients (13.37% vs 10.83%, p=0.011), despite having fewer traditional cardiovascular risk factors.
Why the study?
Cancer patients may have an increased cardiovascular disease risk, making tools for early detection of cardiovascular disease in this population of utmost importance.
Does a cancer diagnosis increase the burden of coronary artery calcification and subsequent cardiovascular events compared to non-cancer patients?
Cohort (n=1,406)
No
Does a cancer diagnosis increase the burden of coronary artery calcification and subsequent cardiovascular events compared to non-cancer patients?
Absolute Event Rate: 13.37% vs 10.83%
p-value: p=0.011
Cancer patients exhibit a higher burden of coronary artery calcification and increased prevalence of cerebrovascular and peripheral arterial disease despite having fewer traditional cardiovascular risk factors.
CACS may stratify CV risk in cancer patients; leaves open whether it should guide management before prospective validation.
BACKGROUND: CT- coronary calcium score, is one of the most studied and widely available modalities in cardiovascular medicine. Coronary artery calcium score (CACS) is an established predictor of coronary artery disease. The 'standard of care' diagnostic modality to measure CACS is ECG-gated Cardiac Multi-Detector Computed Tomography. There is convincing evidence of a strong association between CACS and major cardiovascular (CV) events in asymptomatic individuals. Cancer patients (C) may have a higher risk for CV disease than non-cancer patients (NC) related not only to cancer treatments but also to shared biological factors and pathways. Thus, identifying tools for early detection of CV disease in this population is of utmost importance. METHODS: A retrospective cohort analysis was performed with patients from Cleveland Clinic Florida and Ohio who had CACS from 2017 to 2021. Patients who had cancer diagnosis prior to CACS were matched to NC for age and sex. CV events after their index CACS events were compared between C and NC, and matched control and propensity analysis were conducted. RESULTS: Ten thousand seven hundred forty-two patients had CACS; 703 cancer patients had CACS and were eligible. Extensive CACS (> 400) were significantly higher in cancer, 94 (13.37%) vs non-cancer patients, 76 (10.83%), P = 0.011. Furthermore, after propensity matched analysis, CACS > 400 was 14.8% in C vs 9.6% in NC, P = < 0.05. CV events were similar in both cohorts (p = NS), despite less CV risk factors in cancer patients (P = < 0.05). For the combined moderate (101-400) & extensive (> 400) CACS, the prevalence of stroke and peripheral arterial disease, a marker of systemic atherosclerosis, was significantly higher in patients with cancer (P < 0.01). CONCLUSIONS: Despite having fewer CV risk factors in our study, similar CACS in cancer patients are suggestive of a higher prevalence of CV disease independent of traditional risk factors. High CACS and the overall prevalence of vascular events were more frequent in patients with cancer. Higher prevalence of peripheral arterial disease and cerebrovascular accident further suggests the increased atherosclerotic burden in C.
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Patel et al. (2024) conducted a cohort in Cancer (n=1,406). Cancer diagnosis vs. Non-cancer patients was evaluated on Extensive coronary artery calcium score (> 400) (p=0.011). Cancer patients had a significantly higher prevalence of extensive coronary artery calcium scores (>400) compared to matched non-cancer patients (13.37% vs 10.83%, p=0.011), despite having fewer traditional cardiovascular risk factors.
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