A Case-Control Analysis of Coronary Angiography Findings and Cardiovascular Risk Factors of Cancer and Non-Cancer Patients

Lopez-Mattei, Juan

A Case-Control Analysis of Coronary Angiography Findings and Cardiovascular Risk Factors of Cancer and Non-Cancer Patients

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Dinu V Balanescu, M.D. , Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX

Teodora Donisan, M.D. , Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX

Dominique J Monlezun, MD, PHD, MPH , University of Texas Health McGovern Medical School Houston, Houston, TX

David L. Boone, M.D. , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Frances Cervoni-Curet, M.D. , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Serban M Balanescu, M.D., Ph.D. , Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Michelle Lee, M.D. , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Nicolas Palaskas, M.D. , MD Anderson Cancer Center, Cardiology, Houston, TX

Juan C. Lopez-Mattei, M.D. , Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX

Peter Y Kim, M.D. , Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX

Konstantinos Charitakis, M.D., FSCAI , University of Texas Health Science Center at Houston, Houston, TX

Konstantinos Marmagkiolis, M.D., FSCAI , Florida Hospital Tampa, Wesley Chapel, FL

Cezar A. Iliescu, M.D., FSCAI , The University of Texas - M.D. Anderson, Houston, TX

Background
Cancer and cardiovascular disease share risk factors, leading to an overlap of these conditions. Recent data suggest that cancer itself may be a cardiovascular risk factor. Our objective was to compare cardiovascular risk factors and coronary angiography (CA) findings of cancer patients to those of patients without a history of malignancy.

Methods
This retrospective case-control study enrolled cancer patients from a tertiary cancer center and non-cancer patients from a tertiary cardiology center who underwent CA between 2008-2018. Subjects were classified into 2 groups based on cancer status. Data regarding demographics, laboratory and CA findings, and cancer type and therapy were documented by chart review. Descriptive statistics and propensity score adjusted multivariable regression were used for analysis.

Results
We included 480 patients, of which 240 (50%) had a history of cancer. In the cancer group, 163 (68%) had solid and 77 (32%) hematologic cancers, 154 (64.2%) received chemo- and 72 (30%) radiotherapy. Fewer cancer than non-cancer patients had a family history of premature coronary artery disease (CAD) (13.75% vs. 53.75%, p<0.001), hypertension (73.75% vs. 85%, p=0.002), and diabetes (27% vs. 37.5%, p=0.015). The prevalence of lesions in the left main and right coronary arteries was similar among groups. More non-cancer patients had hemodynamically significant lesions in the left anterior descending (39.17% vs. 25%, p=0.009) and left circumflex (30% vs. 15.83%, p<0.001) arteries. Cancer patients were less likely to have multivessel lesions (odds ratio 0.53, p=0.043).

Conclusions
Our study suggests that cancer patients are less likely to be found with hemodynamically significant CAD on CA and have fewer cardiovascular risk factors. Traditional cardiovascular risk factors may have a more significant impact on CAD than a cancer diagnosis. The indication of CA in cancer patients may be different than CAD suspicion more frequently than non-cancer patients, which leads to a selection bias. Prospective studies regarding the additional cardiovascular risk deriving directly from cancer are needed.