Are cancer survivors at greater risk of coronary artery disease?

Abstract Background Some cancer survivors are at increased risk of coronary artery disease (CAD), due to shared risk factors, effects of cancer or cancer therapy. Typically an asymptomatic condition, CAD has historically been subject to underdiagnosis, thus risk is compounded for at-risk populations. This study investigates the difference in risk factor status between a survivor group undergoing screening for CAD risk, and a control group without cancer, recruited from the same community. Methods 1642 participants were recruited from the community in Victoria and Tasmania, Australia, and their cancer status were evaluated. Risk of CAD was identified via the Pooled Cohort Equation (PCE) and participants were stratified into low (<5%), intermediate (5% - 20%) and high risk (>20%) based on their PCE score. A 3:1 propensity matching based on age and sex was performed to match the cohort between cancer survivors and non-cancer participants. Participants’ baseline characteristics were evaluated. Results After matching, 651 (median age 66 [IQR 9] years, 70.5% female) non-cancer participants and 217 (median age 66 [IQR 10] years, 70.5% female) cancer survivors were included in the analyses. The prevalence of low and intermediate CAD risk in non-cancer population (38.4% and 57.5%, respectively) and cancer survivors (37.3%, and 54.8%, respectively) were similar (p=0.840 and 0.553, respectively). However, 17 (7.8%) of the cancer survivors were identified as high risk, which was significantly greater than non-cancer population (4.1%, p=0.049). The risk profiles of cancer survivors and the non-cancer population (Table 1) suggest a higher prevalence of lipid abnormalities in survivors. Conclusions Cancer survivors have a similar CAD risk profile to control subjects from the same population, but more commonly show lipid abnormalities. Whether this reflects undertreatment in survivors warrants further evaluation.