News | Cardio-oncology | December 21, 2018

Heart Attack, Stroke Risks Increase Leading Up to Cancer Diagnosis

Risk greatest in people with later-stage cancers and lung and colon cancers

Heart Attack, Stroke Risks Increase Leading Up to Cancer Diagnosis

December 21, 2018 — Older adults with cancer are more likely to have had a heart attack or stroke in the months prior to their cancer diagnosis, according to a report published online in Blood.1 The study compared this group with similar adults who do not have cancer during the same period. Lung and colon cancers, as well as advanced-staged cancers, appear to be most strongly associated with an elevated risk of heart attack and stroke caused by blood clots in the arteries.

The study is the largest and most systematic evaluation of these events leading up to a cancer diagnosis, according to researchers at Weill Cornell Medicine, NewYork-Presbyterian, and Memorial Sloan Kettering Cancer Center in New York City.

"Our data show there is an associated risk of ischemic stroke and heart attack that begins to increase in the five months before the cancer is officially diagnosed and peaks in the month just before," said lead study author Babak Navi, M.D., MS, an associate professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. "These results suggest that cancer's effect on the clotting system may be what's predominantly driving the associated risk of heart attacks and stroke."

Cancers can take months and sometimes years to develop and be diagnosed, and some cancers may be exerting biological effects on the body, especially thromboembolic activity, before they come to medical attention, he explained.

Researchers used information from a Medicare database linked to the Surveillance, Epidemiology, and End Results (SEER) registry. They retrospectively looked at the risk of heart attack and stroke in people 67 years and older who were newly diagnosed with breast, lung, prostate, colorectal, bladder, non-Hodgkin lymphoma, uterine, pancreatic, and gastric cancers from Jan. 1, 2005, to Dece. 31, 2013. Together, these cancers account for two-thirds of all cancer diagnoses in the United States. The study included 748,662 Medicare beneficiaries and compared patients with cancer to matched controls during the 360 days before the cancer diagnosis.

Overall, the risk of having a heart attack and stroke jumped by 70 percent in the year before cancer diagnosis. The risk was most acute in the month immediately before cancer diagnosis. During this time, patients who were later diagnosed with cancer were more than five times more likely to have a heart attack or stroke compared with those who did not have cancer – 2,313 of cancer patients had an event compared with 413 of matched controls. Beyond five months before a cancer diagnosis, the risks of these events were similar in both groups. The rate of heart attack or stroke was highest in adults with lung and colorectal cancers and those with stage 3 or 4 disease. When analyzed separately, both heart attack and stroke risk were increased in the months before cancer diagnosis, although heart attack events were slightly more common than strokes. Secondary analyses of additional arterial thromboembolic event types (i.e., thromboembolism of arteries supplying the peripheral limbs or mesentery) further substantiated the primary findings.

The data confirm the association of heart attack and stroke with cancer development and delineate when the risk starts and its relative magnitude, said Navi, who is also chief of the Division of Stroke and Hospital Neurology in the Department of Neurology at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell.

"Our findings suggest that cancer could be a risk factor for arterial thromboembolism, so people who have a heart attack or stroke should be up-to-date with their age- and gender-specific cancer screenings, such as mammograms and colonoscopies," Navi added. "If someone has a heart attack or stroke and there are any concerning signs for an undiagnosed malignancy, such as weight loss or unexplained anemia, then perhaps a cancer screening should be considered."

Navi and his team are planning future research studies to better understand what blood or imaging biomarkers could serve as clues to occult cancer in patients with arterial thromboembolism, as well as what the utility of body computed tomography (CT) imaging or other cancer screening tools might be in these patients, particularly in those whose strokes or heart attacks are otherwise unexplained. Navi also stressed that more investigations are needed to determine the exact cause of arterial thromboembolism in patients with cancer and the optimal strategies to prevent and treat these events.

The use of claims data did not allow the researchers to account for lifestyle factors, such as smoking status, event severity or how interruptions in blood thinning therapies prior to surgical procedures may have played a role. As well, some of the events could have led to a cancer diagnosis because of increased medical surveillance and testing.

This study was funded by the National Institutes of Health.

For more information: www.bloodjournal.org

Reference

1. Navi B.B., Reiner A.S., Kamel H., et al. Arterial thromboembolic events preceding the diagnosis of cancer in older persons. Blood, Dec. 21, 2018. https://doi.org/10.1182/blood-2018-06-860874

Related Content

With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a costly tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. Amyloidosis Patient Registry  #Amyloidosis

With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. This is Figure 2, showing how SPECT imaging allows the reader to distinguish between blood pool activity (ventricular cavity, etc) and myocardial activity and identify regional myocardial differences in radiotracer uptake.

News | Cardiac Diagnostics | March 05, 2020
March 5, 2020 — More than 300 patients have joined the Amyloidosis Patient Registry and it is now available to the en
heart disease image
News | Cardiac Diagnostics | December 18, 2019
December 18, 2019 — In their latest report, “...
FDA Warns Troponin Tests Impacted by Biotin Dietary Supplement
Feature | Cardiac Diagnostics | November 05, 2019 | Dave Fornell, Editor
November 5, 2019 — The U.S.
Videos | Cardiac Diagnostics | October 29, 2019
Doctor Clyde Yancy was a keynote speaker and said doctors need to check their assumptions about patients at the door...
79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event

79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event. Image courtesy of University Hospitals.

News | Cardiac Diagnostics | October 16, 2019
Health and wellness screenings are more than just nice events for the community – they can save lives. A Mentor, Ohio,...
Pesticide Exposure May Increase Heart Disease and Stroke Risk

Image courtesy of zefe wu from Pixabay

News | Cardiac Diagnostics | October 15, 2019
On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy...
World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...