P137 GEOGRAPHIC DIFFERENCES IN CANCER RISK LONG AFTER ACS. THE ABC 7–7A* STUDY ON HEART DISEASE

Abstract

Abstract Background Increased risk of cancer and cancer death has been reported in patients with Acute Coronary Syndrome (ACS). We investigated the long–term geographic differences in those risks. Methods In this prospective study, we enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy. The patients were classified as residing in urban or rural areas in each province. Results With 3 exceptions, all patients completed the 22–year follow–up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre–existing malignancy was noted in 16 patients, whereas 106 patients developed cancer during follow–up and 99 patients died due to the malignancy. The urban/rural incidence rate of new malignancy per 1000 person–years was (9/32 in the north, 19/21 in the middle, and 18/13 in the southern province) and the urban/rural incidence rate of neoplastic death per 1000 person–years was (10/23 in the north, 16/17 in the middle, and 17/11 in the southern province). Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR = 3.0; 95%CI=1.5–6.2; p = 0.02). Also, we found a strong positive interaction between urban/rural areas and provinces with risk increasing from the urban to rural areas from southern to northern provinces (HR 2.1; 95% CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Geographic areas, additionally, showed a strong positive interaction for the risk of cancer death, with risk increasing from the urban to rural areas from southern to northern provinces (HR = 1.9; 95%CI=1.1–3.0; p = 0.01) with the unadjusted Cox regression analysis. The fully adjusted Cox regression and Fine–Gray competing risk regression models provided similar results. We did not observe an urban/rural difference or an interaction between the geographic areas in non–neoplastic death risk. Conclusion This analysis reveals the significant urban/rural difference in the long–term risk of cancer onset and cancer death among unselected ACS patients. These results highlight the importance of implementing a preventive policy based on area–specific knowledge.