Association between coronary artery disease and incident cancer risk: a systematic review and meta-analysis of cohort studies

Abstract

Objective Coronary artery disease (CAD) and cancer are the two leading causes of death worldwide. Evidence suggests the existence of shared mechanisms for these two diseases. We aimed to conduct a systematic review and meta-analysis to investigateassociation between CAD and incident cancer risk. Methods We searched Cochrane, PubMed, and Embase from inception until October 20, 2021, without language restrictions. Observational cohort studies were used to investigate the association between CAD and incident cancer risk. Using random-effects models, the odds ratio (OR) and 95% confidence interval (CI) were calculated. We utilized subgroup and sensitivity analyses to determine the potential sources of heterogeneity and explore the association between CAD and specific cancers. This study was conducted under a pre-established, registered protocol on PROSPERO (CRD42022302507). Results We initially examined 8,533 articles, and included 14 cohort studies in our review, 11 of which were eligible for meta-analysis. Patients with CAD had significantly higher odds of cancer risk than those without CAD (OR = 1.15, 95% CI = [1.08–1.22], I2 = 66%). Subgroup analysis revealed that the incident cancer risk was significantly higher in both sexes and patients with CAD with or without myocardial infarction. Sensitivity analysis revealed that the risk remained higher in patients with CAD even after >1 year of follow-up (OR = 1.23, 95% CI = [1.08–1.39], I2 = 76%). Regarding the specific outcome, the incident risk for colorectal and lung cancers was significantly higher (OR = 1.06, 95% CI = [1.03–1.10], I2 = 10%, and OR = 1.36, 95% CI = [1.15–1.60], I2 = 90%, respectively) and that for breast cancer was lower (OR = 0.86, 95% CI = [0.77–0.97], I2 = 57%) in patients with CAD than in those without CAD. Conclusion CAD may be associated with incident cancer risk, particularly for lung and colorectal cancers, in men and women as well as patients with or without myocardial infarction. Early detection of new-onset cancer and detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality.

Clinical and Biological Predictors of Cancer Incidence and Mortality in Patients with Stable Coronary Artery Disease

“…In recent years, an increasing number of epidemiological and clinical studies have reported that patients with cardiovascular diseases are at higher risk of developing cancer [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. A very recent meta-analysis revealed an increased risk of incident cancer after a CAD event, particularly for lung and colorectal cancers, suggesting that detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality [ 1 ]. However, more research is warranted regarding the causes and risk factors of cancer in these patients [ 1 ].…”

“…A very recent meta-analysis revealed an increased risk of incident cancer after a CAD event, particularly for lung and colorectal cancers, suggesting that detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality [ 1 ]. However, more research is warranted regarding the causes and risk factors of cancer in these patients [ 1 ].…”

“…Recent clinical and epidemiological evidence supports the hypothesis of a bidirectional association between cardiovascular diseases and cancer [ 1 , 2 ]. Patients diagnosed with cancer are more susceptible to developing cardiovascular diseases than healthy subjects [ 3 ].…”

“…Moreover, coronary microvascular dysfunction is associated with cancer incidence in patients presenting with non-obstructive coronary artery disease [ 7 ]. CAD seems to be associated particularly with colorectal and lung cancers [ 1 ].…”

“…For instance, changes in leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn) in blood, which are the expression of genetic instability and DNA damage, are considered other important biological mechanisms initiating and contributing to not only cancer risk [ 20 , 21 ] but also vascular diseases and atherogenesis [ 22 ]. The presence of shortened telomeres and mitochondrial DNA damage is associated with different types of human cancer [ 1 ] and has been verified in human plaques [ 23 ] and peripheral cells of atherosclerotic patients [ 24 ].…”