High Coronary artery calcium score and vascular events more frequent in patients with cancer: Study

In a groundbreaking study conducted at the Cleveland Clinic in Florida and Ohio, researchers have unearthed a compelling link between cancer patients and an increased risk of cardiovascular disease (CVD). The study underscores the importance of considering cardiovascular health in cancer patients, and the association between high Coronary artery calcium score (CACS) and cardiovascular events suggesting the need for targeted cardiovascular risk assessment and management in this population.

The study results were published in the journal BMC - CardioOncology.

The CT coronary calcium score, a highly researched and widely accessible method in cardiovascular medicine, is a well-established predictor of coronary artery disease. ECG-gated Cardiac Multi-Detector Computed Tomography is the recognized 'standard of care' diagnostic tool for measuring coronary artery calcium score (CACS). Robust evidence underscores a compelling connection between CACS and significant cardiovascular (CV) events in individuals with no cardiovascular disease symptoms. Notably, cancer patients (C) may face an elevated risk of CV disease compared to their non-cancer counterparts (NC), a risk attributed not only to cancer treatments but also to shared biological factors and pathways. Hence researchers conducted a retrospective cohort analysis to evaluate the use of CACS as a screening tool for the early identification of cardiovascular diseases in cancer patients.

The retrospective cohort analysis involved a meticulous matching of cancer patients to non-cancer counterparts based on age and sex. Cardiovascular events after their initial Coronary Artery Calcium Score (CACS) assessments were contrasted between individuals with a cancer history (C) and those without cancer (NC). Cardiovascular events after their initial Coronary Artery Calcium Score (CACS) assessments were contrasted between individuals with a cancer history (C) and those without cancer (NC).

Findings:

• One of the key revelations was the significantly higher prevalence of extensive CACS (scores greater than 400) in cancer patients compared to their non-cancer counterparts.
• The data indicates that cancer patients, despite having fewer traditional cardiovascular risk factors, exhibited a noteworthy increase in high CACS, suggesting an independent association between cancer and cardiovascular health.
• Intriguingly, even after conducting a propensity-matched analysis to account for potential confounders, cancer patients (14.8%) continued to display a higher prevalence of CACS greater than 400 underscoring the importance of recognizing cancer as a potential independent risk factor for cardiovascular disease.
• Despite cancer patients having fewer traditional cardiovascular risk factors, the study revealed that the occurrence of cardiovascular events was similar in both cohorts.
• Digging deeper into the moderate (101–400) and extensive (>400) CACS categories, the study found a notable increase in the prevalence of stroke and peripheral arterial disease in cancer patients.

These findings suggest that the atherosclerotic burden in cancer patients extends beyond the coronary arteries, encompassing a more systemic involvement.

This study has broader implications for clinical practice, emphasizing the need for heightened vigilance in monitoring cardiovascular health in cancer patients. It highlights the importance of considering cancer not only as a disease in isolation but as a condition that may influence cardiovascular risk in unexpected ways. Early detection of high CACS in cancer patients becomes paramount, offering a window of opportunity for proactive cardiovascular risk management in this unique population.

While the study provides valuable insights, it is essential to acknowledge its retrospective nature and the need for further research to explore specific cancer types, treatments, and individual patient characteristics that may contribute to these intriguing connections between cancer and cardiovascular health.

Further reading: Patel, S., Franco, F.X., McDonald, M. et al. Use of computed tomography coronary calcium score for prediction of cardiovascular events in cancer patients: a retrospective cohort analysis. Cardio-Oncology 10, 1 (2024). https://doi.org/10.1186/s40959-023-00196-9