Abstract 13760: Long-Term Cancer Risk After Acute Coronary Syndrome in Selected Urban and Rural Areas. The ABC-7b* Study on Heart Disease

Abstract

Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). We attempted to investigate the geographic differences in this risk. Methods: In this prospective study, we enrolled 525 ACS patients admitted to 3 hospitals in Veneto region of Italy and discharged alive and free from neoplasia. Patients’ residency was classified into 2 urban and 2 nearby rural areas. We report the risk of neoplasia associated with smoking as a comparison. Results: With 3 exceptions, all patients completed a 24-year follow-up unless pre-empted by death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. During the follow-up period, which represented 5851 person-years, 114 (22%) patients developed cancer. The cancer incidence rate was 17 and 22 per1000 person-years for urban and rural areas, respectively. No difference in cancer onset risk was found between urban and rural areas or between southern and northern provinces (HR 1.3; 95%CI 0.9–1.9; p = 0.21 and HR 1.4; 95% CI 0.9–2.0; p = 0.08, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 2.9; 95% CI 1.3–6.5; p = 0.01). The fully adjusted model provided similar results. The HR for malignancy onset after ACS by smoking habit was (1.3; 95% CI 0.8–2.0; p = 0.26) in the unadjusted Cox regression model. Conclusion The present prospective study shows that the cancer onset risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography with the northern rural area having the highest risk. The risk seems to be higher than that observed with smoking habits. Figure 1. Graphical representation of the interaction analysis.