Abstract
Background: Atherosclerosis and cancer share multiple disease pathways. Yet, it is unclear if atherosclerosis is associated with a subsequent higher cancer risk. We determined the association of atherosclerotic calcification in the aortic arch, as proxy for systemic atherosclerosis, with the risk of cancer.Methods: Between 2003 and 2006, 2,404 participants (mean age: 69.5 years, 52.5% women) from the prospective population-based Rotterdam Study underwent computed tomography to quantify calcification in the aortic arch. Participants were followed for the onset of cancer, death, loss to follow-up, or January 1st, 2015, whichever came first. We computed sex-specific tertiles of aortic arch calcification volumes. Next, we examined the association between the volume and severity (i.e., tertiles) of aortic arch calcification and the risk of cancer using Cox proportional hazard models.Results: During a median (interquartile range) follow-up of 9.6 years (8.9–10.5), 348 participants were diagnosed with cancer. Participants with the greatest severity of aortic arch calcification had a higher risk of cancer [hazard ratio for the third tertile compared to the first tertile of aortic arch calcification volume in the total population is 1.39 (95% CI = 1.04–1.86)].Conclusions: Individuals with the most severe aortic arch calcification had a higher risk of cancer. While this could reflect the impact of long-term exposure to shared risk factors, it might also point toward the co-occurrence of both conditions.
Highlights
Cardiovascular diseases and cancer remain the leading causes of morbidity and mortality worldwide [1, 2]
When investigating tertiles of calcification, we found that severe calcification was associated with a higher risk of cancer in the total population and in men
When censoring participants with a follow-up duration longer than 2 years, we found that effect estimates were higher for both continuous aortic arch calcification volume as well as for severe calcification, albeit not statistically significant
Summary
Cardiovascular diseases and cancer remain the leading causes of morbidity and mortality worldwide [1, 2]. Several studies have shown that patients with cancer are at higher risk of developing cardiovascular disease [3, 4]. This may be due to a cancer-induced hypercoagulable state [5], or as a consequence of the detrimental effects of cancer treatment on the vascular system [4, 6, 7]. Atherosclerosis and cancer share multiple disease pathways. It is unclear if atherosclerosis is associated with a subsequent higher cancer risk. We determined the association of atherosclerotic calcification in the aortic arch, as proxy for systemic atherosclerosis, with the risk of cancer
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