Association of cancer survivorship with coronary plaque and necrotic core burden
J Wang, C H Soh, S Khanna, S Tan, M Nolan, N Nerlekar, T H MarwickAbstract
Introduction
Cancer survivors have an increased risk of cardiovascular diseases. While clinical events such as myocardial infarction and coronary artery disease are well described, less Is known about the burden and phenotype of subclinical atherosclerosis in this population. Quantifying coronary plaque burden may provide mechanistic insights into the excess risk and inform targeted prevention strategies.
Purpose
To assess the association between cancer survivorship with coronary plaque burden and composition on coronary computed tomography angiography (CCTA).
Methods
This cross-sectional analysis included cancer survivors ≥5 years post-therapy and non-cancer controls from prospectively enrolled CCTA screening cohorts. Only participants with coronary artery calcium (CAC) score of 1-400 were included. Primary outcomes were total plaque burden and necrotic core per atheroma volume (PAV), defined as plaque volume over vessel volume. Secondary outcomes were fibrofatty, fibrous, and calcified PAV. Multivariable linear regression was used to assess the association between survivorship with log-transformed plaque PAV, adjusted for age, sex, systolic blood pressure, diabetes, eGFR, smoking, and BMI. Additional models incorporated lipids and CAC to assess attenuation.
Results
Our study included 97 cancer survivors (63.9% breast cancer, 15.5% haematological malignancies) and 365 non-cancer controls. Survivors were older (67.7± 4.4 vs 58.3 ± 6.9 years, p<0.001) and more often female (77.3% vs 42.4%, p<0.001), with a higher prevalence of diabetes (6.2% vs 1.4%, p=0.014), hypertension (42.2% vs 22,2%, p<0.001) and dyslipidaemia (18.6% vs 11.0%, p=0.045). In unadjusted analyses, survivors demonstrated higher total plaque burden (39.4% vs 35.20%; p<0.001) and necrotic core PAV (1.33% vs 0.84%; p=0.002). Secondary analyses showed higher calcified PAV (12.87% vs 7.34%; p<0.001), while no significant differences were identified in fibrofatty and fibrous PAV. In the primary adjusted models, cancer survivorship was associated with a 10% higher total plaque burden (exp[β] 1.10, 95% CI 1.02–1.18; p=0.011) and a 45% higher necrotic core burden (exp[β] 1.45, 95% CI 1.11–1.91; p=0.007) relative to non-cancer controls. In propensity score–matched cohorts (n=67 per group), differences in total plaque and necrotic core burden remained statistically significant. Further adjustment for lipids and CAC modestly attenuated associations without loss of significance (fully adjusted necrotic core exp[β] 1.44, 95% CI 1.09–1.89; p=0.010).
Conclusions
Long-term cancer survivorship independently associated with greater total coronary plaque burden, especially necrotic core burden. These findings suggest a quantitatively greater and compositionally distinct coronary atherosclerotic burden in cancer survivors, warranting prospective evaluation of clinical implications.Plaque Burden in Cancer SurvivorsDeterminants of Coronary Plaque Burden