Sex influence on cancer incidence after a cardiovascular event: a population study
H Morillas Climent, P Moliner, A Ricarte-Marin, N Lopez-Fernandez, S Jovells-Vaque, A E Cosa, A Pons-Riverola, A Garay, S Jimenez-Marrero, R Ramos, J Berdejo, C Enjuanes, E Hidalgo-Quiros, M Soler, J Comin-ColetAbstract
Background
Cardiovascular disease (CVD) and cancer share common risk factors and pathophysiological pathways. Previous studies have shown that patients with prevalent CVD present an increased risk of developing cancer in the future. Nevertheless, the effect of biological sex on cancer incidence after a recent cardiovascular event remains largely unexplored.
Purpose
To analyze the influence of biological sex on mid-long term incidence of cancer in patients with a new diagnosis of CVD. To evaluate the impact of sex on cancer outcomes according to the concrete type of cardiovascular event.
Methods
We performed a retrospective population-based cohort study using data from 2010-2022 clinical and administrative databases from our healthcare area. All adults (>18 years) without a prior history of cancer or CVD at first medical contact were included. During a run-in period of 24 months, patients with a new diagnosis of cancer or CVD were excluded. After this initial timeline, patients were classified into 2 groups in a dynamic manner depending on the presence or absence of new CVD, as defined by International Classification of Disease (ICD) 9th and 10th editions. The primary outcome of interest was incident cancer, also ascertained by means of ICD codes after the 24-month run-in period. Nonmelanoma skin cancers were not included. Statistical analysis comprised cox proportional hazards models adjusted for age, diabetes, hypertension, dyslipidemia and smoking.
Results
A total of 238,415 adults were included, of whom 52.20% were women. Compared to men, women were older (45.9 vs 43.7 years, p<0.01) and had a higher prevalence of anemia (10.73 vs 45.8%, p<0.01= and depression (5.48% vs 2.40%, p<0.01), whilst men presented a greater history of alcohol abuse (5.75% vs 1.15%, p<0.01) and chronic obstructive pulmonary disease (5.92% vs 3.14%, p<0.01). When compared to patients without a prior history of CVD, patients with a new diagnosis of CVD showed an increased risk of incident cancer over time, with and adjusted hazard ratio (HR) of 1.56 (95%CI 1.47-1.67) (picture 1). When stratified by biological sex, cancer incidence was similar between males and females without prior CVD. Nevertheless, in the subgroup of patients with a new diagnosis of CVD, men exhibited a higher risk of cancer over time compared to women (HR 1.13; 95%CI 1.08-1.18; picture 2). Regarding type of CVD, men showed a higher risk of incident cancer in relation to women when the cardiovascular event was heart failure, coronary heart disease or cerebrovascular disease, but not in the case of atrial fibrillation.
Conclusion
Patients with newly diagnosed CVD present a higher risk of cancer when compared to patients without a history of prior CVD. When patients with CVD are subclassified by biological sex, men show a higher risk of incident cancer over time.Cancer Incidence Stratified by Presence Cancer Incidence Stratified by Sex and P