Incident Cardiovascular Events Among Healthy Subjects are Associated with Increased Risk of Subsequent Cancer Diagnosis

Purpose: This study investigated the association between incident CVD events future cancer among apparently healthy subjects. Methods: We evaluated asymptomatic self-referred adults who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event. Results: Final study population included 26,574 subjects. Median age was 46 years (Interquartile range [IQR] 40-53) and 69% were men. During median follow up time of 10 years (IQR 3-16) 2,463 (9%) subjects developed CVD, 2,040 (8%) developed cancer and 869 (3%) died. Most common cancer types were prostate among men (N=406, 2.2%) and breast among women (N= 283, 3.4%). Compared with patients who were free of CVD and cancer during follow up, risk of death was 5, 34 and 54 times higher for patients who developed CVD event, cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 50% more likely to develop cancer in a univariate model (95% Confidence Interval [CI] 1.3-1.7, p<.001). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (<= 52 years; N=19,052) incident CVD was associated with a significant 30% increased risk of subsequent cancer diagnosis (p for interaction =.018). Conclusion: Incident CVD is independently associated with increased risk of subsequent cancer diagnosis among young adults. Active cancer surveillance should be considered among young patients recovering from a CVD event.