Epidemiology of ischemic heart disease among white males: I. Relationship between coronary atherosclerosis and cancer of various sites

Abstract

1. 1. An epidemiologic study was made of the relationship between cancer and ischemic heart disease among white males, utilizing an autopsy population. The coronary arteries of patients with cancer of 11 different sites were compared with the coronary arteries of accident victims. The records were matched for age, sex, race, year of death within a 5 year limit, and other factors known to influence the prevalence of coronary atherosclerosis. Adjustments were made also for hypertension and body weight at time of death. Next, the coronary arteries of cancer patients were compared with those of “all other (noncancer) patients” in the autopsy population. 2. 2. There were no significant differences in the severity of coronary artery atherosclerotic blockage or coronary clot formation when cancer patients were compared with accident victims. However, cancer patients had significantly less severe coronary artery atherosclerotic blockage and fewer coronary clots when they were compared with all other (noncancer) patients in the autopsy population. These conflicting results constitute an example of Berkson's fallacy. It was reasoned that accident victims were the group in the autopsy population whose coronary arteries should be most representative of those of the general population. On the other hand, the coronary arteries of all other (noncancer) patients in the autopsy population were heavily weighted with atherosclerotic conditions such as ischemic heart disease, diabetes mellitus, and hypertension. 3. 3. It was concluded that there is no association—either positive or negative—between cancer and coronary artery atherosclerotic blockage or coronary artery clot formation. This finding appears to contradict recent epidemiologic and pathologic evidence which tended to link together cancer, especially lung cancer, and atherosclerosis.