Risk of Cancer After Diagnosis of Cardiovascular Disease

Abstract Background Cardiovascular disease (CVD) and cancer share several risk factors. While preclinical models show that various types of CVD can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk. Objectives To determine whether CVD, especially atherosclerotic CVD, is independently associated with incident cancer. Methods Using IBM MarketScan claims data from over 130 million individuals, we identified 27 million cancer-free subjects with a minimum of 36 months of follow-up data. Individuals were stratified by presence or absence of CVD, with 1:1 propensity matching to control for cardiovascular risk factors, and cumulative risk of cancer was calculated. Additional analyses were performed according to CVD type (atherosclerotic vs non-atherosclerotic) and cancer subtype. Results Among 4,487,412 matched individuals, those with CVD had a 1.26-fold higher relative risk of cancer than those without CVD (6.8% vs 5.4% 5-year cumulative incidence). Results were more pronounced for individuals with atherosclerotic CVD (aCVD), who had a 1.43-fold higher relative risk than those without CVD (7.7% 5-year cumulative cancer incidence). Findings persisted after multivariable adjustment for numerous traditional CV risk factors, including the modestly higher risk for cancer amongst individuals with atherosclerotic CVD. Cancer subtype analyses showed specific associations of aCVD with several malignancies, including lung, bladder, liver, brain, and other hematologic cancers. Conclusions Individuals with CVD have an increased risk of developing cancer compared to those without CVD. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.