Association of Subclinical Cardiac Remodeling With Incident Cancer in the MESA Cohort

Background Patients with established cardiovascular disease have an increased risk of cancer; however, the association between subclinical cardiac remodeling and cancer development remains unclear. We aimed to examine the association between cardiac magnetic resonance imaging–derived measures of subclinical cardiac remodeling and incident cancer in the MESA (Multi‐Ethnic Study of Atherosclerosis) cohort. Methods Multivariable Cox proportional hazards models were used to estimate the association between each cardiac magnetic resonance imaging measure of interest and the incidence of cancer, separately, for an all‐inclusive cancer end point as well as prostate, breast, female‐specific, colorectal, and lung cancer subtypes. Results Of 6214 participants with cancer data available (median age, 61.0 years; 52.7% women), 4595 had at least 1 cardiac magnetic resonance imaging–derived measure of interest, with 563 cancer events over a median follow‐up of 18.7 years. Overall cancer incidence was higher with greater left ventricular mass index or left ventricular mass/volume ratio, and lower with higher left atrial emptying fraction or peak left atrial longitudinal strain. In adjusted Cox proportional hazards models, left ventricular mass index was significantly associated with the hazard of breast cancer (hazard ratio [ HR] , 1.88 [95% CI , 1.19–2.97]; P =0.007), and peak left atrial strain was significantly associated with the hazard of colorectal cancer ( HR , 0.52 [95% CI , 0.33–0.82]; P =0.005). Conclusions In the MESA cohort, elevated left ventricular mass index and worse (lower) peak left atrial strain were associated with an increased risk of breast cancer and colorectal cancer, respectively. Subclinical cardiac remodeling may serve as an early marker to identify individuals at risk for both cardiovascular disease and cancer.