Key result
Cancer survivorship linked to ~10% higher total plaque volume and more low-attenuation plaque versus controls.
Why the study?
The increased risk of atherosclerotic cardiovascular disease in cancer survivors is not fully elucidated, and coronary plaque burden and composition in survivors remained unclear.
Is long-term cancer survivorship associated with greater coronary plaque burden and more adverse plaque composition compared to non-cancer controls?
Cohort (n=462)
Is long-term cancer survivorship associated with greater coronary plaque burden and more adverse plaque composition compared to non-cancer controls?
Long-term cancer survivors exhibit a higher coronary plaque burden relative to vessel volume, particularly high-risk low-attenuation plaque, which may contribute to their increased cardiovascular risk.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our previous studies have shown cancer survivors face nearly double the risk of cardiovascular disease. This study adds to that picture by showing survivors also carry a greater volume of high-risk plaque. It tells us we need to be more proactive with heart risk assessment and management in this group.”
May support enhanced CV surveillance in long-term survivors; leaves open whether plaque differences drive events in prospective cohorts.
Background The increased risk of atherosclerotic cardiovascular disease in cancer survivors is not fully elucidated. Understanding the coronary plaque burden and composition in survivors could address this gap. Objectives To determine whether cancer survivorship is associated with greater coronary plaque burden and more adverse plaque than non-cancer controls. Methods This analysis included asymptomatic cancer survivors ≥5 years after therapy and non-cancer controls from prospectively enrolled CT coronary angiography screening cohorts. Primary outcomes were total plaque burden and low-attenuation plaque (LAP) percent atheroma volume (PAV, defined as plaque volume over vessel volume). Linear regression was used to assess the association of survivorship with log-transformed plaque measures, adjusted for age, sex, blood pressure, diabetes, glomerular filtration rate, smoking, and body mass index. Results Among 1,725 screened participants, this study included 97 cancer survivors (63.9% breast cancer, 15.5% haematological malignancies) and 365 intermediate-risk controls with a coronary artery calcium (CAC) score of 1-400. Survivors were older (67.7±4.4 vs 58.3±6.9 years), more often female (77.3% vs 42.4%), and had more comorbidities (all p<0.050). Cancer survivorship was associated with 10% higher total plaque PAV (95% CI 1.02–1.18; p=0.011) and 45% higher LAP PAV (95% CI 1.11–1.91; p=0.007). The association persisted after propensity matching and further adjustment for lipids and CAC. Absolute LAP volume did not differ overall (1.47 vs 1.86 mm3; p=0.41), but survivors had markedly smaller vessels (125 vs 224 mm3; p<0.001). After adjustment for vessel volume, LAP burden was higher in survivors whether expressed as PAV (1.56; p=0.002) or absolute volume (1.43; p<0.001) Conclusions Within this selected, statin-naïve cohort with CAC scores of 1-400, cancer survivorship was associated with greater plaque burden relative to measured vessel volume, with the clearest association observed for LAP.
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Soh et al. (2026) conducted a cohort in Coronary plaque burden in cancer survivors (n=462). Cancer survivorship vs. Non-cancer controls was evaluated on Total plaque burden and low-attenuation plaque (LAP) percent atheroma volume (PAV) (10% higher total plaque PAV, 95% CI 1.02-1.18, p=0.011). Cancer survivorship was associated with 10% higher total plaque percent atheroma volume and 45% higher low-attenuation plaque vs controls.
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