Abstract 9271: Risk of Cancer After Diagnosis of Cardiovascular Disease

Abstract

Introduction: Cardiovascular disease (CVD) and cancer share several known risk factors. While preclinical models have found that various types of CVD can accelerate cancer progression, clinical studies have not determined whether these associations are due to shared risk factors or a specific impact of atherosclerosis on cancer development. Hypothesis: CVD, particularly atherosclerotic CVD, is an independent risk factor for incident cancer. Methods: We used a 1:1 matched retrospective cohort study using IBM’s MarketScan insurance claims database from 2009 to 2019. Those with CVD were stratified as having either atherosclerotic (aCVD) or non-atherosclerotic disease (naCVD). Those with prior diagnostic codes for cancer were excluded. Cumulative risks of (1) any incident cancer, (2) organ-specific cancers according to CVD groups. Kaplan-Meier and multivariable adjusted Cox proportional hazards (PH) models with propensity score adjustment were used to evaluate the association of CVD groups and cancer. Results: Among 4,487,412 matched (1:1 no CVD vs. CVD) individuals, the mean age was 56 years, 48% were female, 31% had aCVD, and 19% had naCVD. Those without CVD had a 5-year cumulative cancer incidence of 5.4% (95% CI, 5.3%-5.4%), compared to 6.8% (95% CI, 6.7%-6.8%) among those with any CVD and 7.7% (95% CI, 7.6%-7.8%) for those with aCVD. After multivariable and propensity score adjustment, individuals with CVD were found to have a significantly increased risk of incident cancer compared to individuals without CVD (hazard ratio [HR], 1.14; 95% CI, 1.13-1.15). Those with aCVD had a significantly higher risk of cancer compared to the naCVD group (HR, 1.03; 95% CI, 1.02-1.05). These findings were consistent in sensitivity analyses which were further adjusted for smoking history and body mass index. Cancer subtype analyses showed a specific association of aCVD with lung, bladder, liver, brain, and other hematologic cancers. Conclusions: In this retrospective cohort study, individuals with CVD had an increased risk of incident cancer compared to those without CVD. This association may be driven by the relationship of aCVD with specific cancer subtypes, which persists after controlling for conventional risk factors.