Abstract
BackgroundWe have previously reported an increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis (AS). These findings were the result of a post-hoc analysis from a large echocardiography database and needed verification. Our aim was to determine, using a different study population, whether young patients with AS are at increased risk for cancer.MethodsA large echocardiographic database was used to identify patients (age ≥ 20 years) with moderate or severe AS (study group) and patients without aortic stenosis (comparative group). The new occurrence of non-hematological malignancies was determined after the index date (first echo with moderate or severe AS or first recorded echo in the control group).ResultsThe final study group included 7013 patients with AS and 98,884 without AS. During a median follow-up of 6.9 years (3.0–11.1) there were 10,705 new cases of non-hematological cancer. The crude incidence rate of cancer was higher in AS compared to non-AS patients (22.3 vs. 13.7 per 1000 patient-year, crude HR 1.58 (95%CI 1.46–1.71). After adjustment for relevant covariates, there was no difference between groups (HR 0.93, 95% CI 0.86–1.01). Only patients in the lowest age quartile (20–49.7 years), had an increased adjusted risk of cancer (HR 1.91, 95%CI 1.08–3.39). The HR for the risk of cancer associated with AS was inversely proportional to age (P < 0.001 for the interaction between AS and age).ConclusionsYoung patients with moderate or severe AS may have an increased risk for cancer. Cancer surveillance should be considered for young patients with AS.
Highlights
Reverse cardio-oncology has been recently proposed as a new field, dealing with inherent cancer risk in patients with cardiovascular disease [1]
We have previously shown in a transverse aortic constriction (TAC) murine model, that early cardiac remodeling secondary to pressure overload, without heart failure (HF), is associated with increased risk of cancer [9]
Cardiac remodeling was associated with increased tumor growth and metastasis seeding, which was suggested to be mediated by periostin, a matrix protein that enhances cancer cell proliferation
Summary
Reverse cardio-oncology has been recently proposed as a new field, dealing with inherent cancer risk in patients with cardiovascular disease [1]. To determine whether causal relationship exists between HF and the development of cancer, Meijers et al used a mouse model of myocardial infarction and HF, and showed increased intestinal tumor growth, proportional to the amount of scar tissue in the left ventricle and inversely proportional to left ventricular ejection fraction [7]. This effect was mediated by cardiac secreted proteins. We have previously reported an increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis (AS) These findings were the result of a post-hoc analysis from a large echocardiography database and needed verification. Our aim was to determine, using a different study population, whether young patients with AS are at increased risk for cancer
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