Coronary microvascular dysfunction is an independent predictor of developing cancer in patients with non-obstructive coronary artery disease

Abstract

Background Cardiovascular disease and cancer share common pathogenesis and risk factors. Coronary microvascular dysfunction (CMD), reflecting impaired coronary microvascular dilation in response to stress, is related to a higher risk of major cardiovascular events; however, its association with cancer has not been explored. Methods A retrospective study on 1042 patients with non-obstructive coronary artery diseases was performed. Data regarding demographic, clinical history, diagnostic coronary reactivity test, and cancer occurrence was collected. CMD was defined as coronary flow reserve (CFR, the ratio of hyperemic blood flow to resting blood flow) ≤2.5. Results Thirty-four percent had CMD (67.4% female and the average age was 52.4 ± 12.2 years). Of 917 patients with no history of cancer, 15.5% developed cancer during follow-up (median of 9 (4,16) years). Kaplan-Meier analysis showed CMD patients had lower cancer-free survival compared to those without CMD (log-rank p = 0.005). Cox proportional hazard analyses showed that after adjusting for age, sex, hypertension, diabetes, smoking, and glomerular filtration rate, CMD is independently associated with cancer (HR, 1.4, 95%CI, 1.09-2.04, p = 0.04). The rate of MACE was significantly higher in CMD compared to those non-CMD patients in patients who had a previous history of cancer (OR, 2.5, 95%CI, 1-6.2, p = 0.04) and patients with no history of cancer (OR, 1.4, 95%CI, 1.01-1.9, p = 0.044). Conclusion CMD is associated with cancer incidence in patients presenting with non-obstructive coronary artery diseases. This study emphasizes the following-up in patients with CMD to evaluate the risk of MACE as well as potential malignant diseases.

Early microvascular coronary endothelial dysfunction precedes pembrolizumab-induced cardiotoxicity. Preventive role of high dose of atorvastatin

“…Therefore, the pharmacological management of ICI-derived early coronary endothelial dysregulation might serve as a druggable target for the mitigation of both cardiac dysfunction and vascular-driven CVAEs by anti-PD-1 therapy. Importantly, microvascular endothelial dysfunction is an independent predictor of cancer development and progression, as it is shown that patients with nonobstructive coronary artery diseases have a higher incidence of malignancies [34,65]. Targeting microvascular coronary endothelial dysfunction in anti-PD-1 therapy might facilitate the parallel treatment of both cancer progression and CVAEs.…”

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

“…In recent years, more attention has been paid to the hazards of CMD. Rajai et al reported that CMD was closely related to the development of cancer in patients with non-obstructive coronary artery disease [ 28 ]. The cerebral-coronary connection study suggested that CMD patients were more likely to have cognitive impairment [ 29 ].…”

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 ].…”

“…Moreover, subjects who have developed myocardial infarction (MI) have higher short- and long-term hazard ratios for cancer than those without MI [ 4 ], and patients with atherosclerotic cardiovascular diseases exhibit two-fold higher incidence of cancer development than those with non-atherosclerotic CVD [ 6 ]. 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 ].…”