Incident cardiovascular events are associated with higher risk of subsequent cancer diagnosis

Background: Cardiovascular disease (CVD) and cancer share common risk factors. However, data on the association between incident CVD and the risk of future cancer diagnosis is limited. Methods: We evaluated asymptomatic self-referred adults aged 40-79 years who participated in a screening program. All subjects were free of CVD and cancer at baseline. Cancer data was available for all subjects from a national registry. Atherosclerotic cardiovascular disease (ASCVD) risk was calculated using Pooled Cohort Equations (PCE) model. CVD was defined as acute coronary syndrome, percutaneous coronary intervention or stroke. Primary end-point was development of cancer during follow up. Results: Final study population included 15,608 patients. Median age was 50 years (Interquartile range [IQR] 44-55) and 72% were men. During median follow up time of 10 years (IQR 6-15) 1,150 (7%) subjects developed CVD and 1,341 (9%) developed cancer. Most common cancer types were prostate among men (N=297, 1.9%) and breast among women (N= 188, 1.2%). Univariate Cox regression model with CVD as a time dependent covariate showed that subjects who developed CVD during follow up were 60% more likely to develop cancer (95% Confidence Interval [CI] 1.3-1.97, p<.001). However, after adjustment for ASCVD PCE risk score and additional CVD risk factors, the association of incident CVD with cancer diagnosis was no longer significant (p=0.33). Sub-analysis of younger patients’ group (age < 50, N=7,678) showed that CVD events during follow up were associated with a significant 90% increased risk of cancer diagnosis in the comprehensive multivariate model (95% CI 1.1-3.3, p=0.028; p for interaction =.035). Conclusions: Incident CVD is independently associated with higher risk of subsequent cancer diagnosis in young adults. Our analysis underscores the importance of cancer surveillance among young patients with CVD.