Key result
Moderate or severe aortic stenosis did not increase overall non-hematological cancer risk (HR 0.93) but significantly increased risk in young patients aged 20-49.7 years (HR 1.91).
Why the study?
Prior post-hoc findings of increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis required verification in a different study population.
Does moderate or severe aortic stenosis increase the risk of non-hematological cancer in adult patients?
Cohort (n=105,897)
No
Does moderate or severe aortic stenosis increase the risk of non-hematological cancer in adult patients?
Hazard Ratio: 0.93 (95% CI 0.86–1.01)
Absolute Event Rate: 22.7% vs 13.7%
Young patients (20-49.7 years) with moderate or severe aortic stenosis have a significantly increased risk of developing non-hematological cancer, suggesting a potential need for cancer surveillance in this specific population.
Young AS patients may need heightened cancer vigilance; leaves open causality and screening utility pending prospective data.
BACKGROUND: We have previously reported an increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis (AS). These findings were the result of a post-hoc analysis from a large echocardiography database and needed verification. Our aim was to determine, using a different study population, whether young patients with AS are at increased risk for cancer. METHODS: A large echocardiographic database was used to identify patients (age ≥ 20 years) with moderate or severe AS (study group) and patients without aortic stenosis (comparative group). The new occurrence of non-hematological malignancies was determined after the index date (first echo with moderate or severe AS or first recorded echo in the control group). RESULTS: The final study group included 7013 patients with AS and 98,884 without AS. During a median follow-up of 6.9 years (3.0-11.1) there were 10,705 new cases of non-hematological cancer. The crude incidence rate of cancer was higher in AS compared to non-AS patients (22.3 vs. 13.7 per 1000 patient-year, crude HR 1.58 (95%CI 1.46-1.71). After adjustment for relevant covariates, there was no difference between groups (HR 0.93, 95% CI 0.86-1.01). Only patients in the lowest age quartile (20-49.7 years), had an increased adjusted risk of cancer (HR 1.91, 95%CI 1.08-3.39). The HR for the risk of cancer associated with AS was inversely proportional to age (P < 0.001 for the interaction between AS and age). CONCLUSIONS: Young patients with moderate or severe AS may have an increased risk for cancer. Cancer surveillance should be considered for young patients with AS.
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Saliba et al. (2021) conducted a cohort in Aortic stenosis (n=105,897). Moderate or severe aortic stenosis vs. No aortic stenosis was evaluated on New occurrence of non-hematological malignancies (HR 0.93, 95% CI 0.86-1.01). Moderate or severe aortic stenosis did not increase overall non-hematological cancer risk (HR 0.93) but significantly increased risk in young patients aged 20-49.7 years (HR 1.91).
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