Division of Vascular Surgery, Department of Surgery (L.L., C.F.B., R.A.B., S.S.A., C.F., D.K., N.J.L.), Stanford University School of Medicine, Palo Alto, CA.
Stanford Cardiovascular Institute, CA (L.L., C.F.B., R.A.B., S.S.A., C.F., N.J.L.).
Arterioscler Thromb Vasc Biol. 2024 Jul;44(7):1694-1701. doi: 10.1161/ATVBAHA.123.320543. Epub 2024 May 23.
Epidemiological and mechanistic data support a potential causal link between cardiovascular disease (CVD) and cancer. Abdominal aortic aneurysms (AAAs) represent a common form of CVD with at least partially distinct genetic and biologic pathogenesis from other forms of CVD. The risk of cancer and how this risk differs compared with other forms of CVD, is unknown among AAA patients. We conducted a retrospective cohort study using the IBM MarketScan Research Database to test whether individuals with AAA have a higher cancer risk independent of traditional shared risk factors.
All individuals ≥18 years of age with ≥36 months of continuous coverage between 2008 and 2020 were enrolled. Those with potential Mendelian etiologies of AAA, aortic aneurysm with nonspecific anatomic location, or a cancer diagnosis before the start of follow-up were excluded. A subgroup analysis was performed of individuals having the Health Risk Assessment records including tobacco use and body mass index. The following groups of individuals were compared: (1) with AAA, (2) with non-AAA CVD, and (3) without any CVD.
The propensity score-matched cohort included 58 993 individuals with AAA, 117 986 with non-AAA CVD, and 58 993 without CVD. The 5-year cumulative incidence of cancer was 13.1% (12.8%-13.5%) in participants with AAA, 10.1% (9.9%-10.3%) in participants with non-AAA CVD, and 9.6% (9.3%-9.9%) in participants without CVD. Multivariable-adjusted Cox proportional hazards regression models found that patients with AAA exhibited a higher cancer risk than either those with non-AAA CVD (hazard ratio, 1.28 [95% CI, 1.23-1.32]; <0.001) or those without CVD (hazard ratio, 1.32 [95% CI, 1.26-1.38]; <0.001). Results remained consistent after excluding common smoking-related cancers and when adjusting for tobacco use and body mass index.
Patients with AAA may have a unique risk of cancer requiring further mechanistic study and investigation of the role of enhanced cancer screening.
流行病学和发病机制数据支持心血管疾病（CVD）和癌症之间存在潜在的因果关系。腹主动脉瘤（AAA）是一种常见的 CVD 形式，其遗传和生物学发病机制至少部分与其他 CVD 形式不同。AAA 患者的癌症风险以及与其他 CVD 形式相比风险如何不同尚不清楚。我们使用 IBM MarketScan 研究数据库进行了一项回顾性队列研究，以测试 AAA 患者是否存在独立于传统共同风险因素的更高癌症风险。
纳入 2008 年至 2020 年期间至少有 36 个月连续覆盖的所有≥18 岁的个体。排除具有 AAA 潜在孟德尔病因、无特定解剖位置的主动脉瘤或在随访开始前有癌症诊断的个体。对纳入了健康风险评估记录（包括吸烟和体重指数）的个体进行了亚组分析。比较了以下三组个体：（1）有 AAA，（2）有非 AAA-CVD，和（3）无任何 CVD。
倾向评分匹配队列纳入了 58993 例 AAA 患者、117986 例非 AAA-CVD 患者和 58993 例无 CVD 患者。AAA 患者的 5 年累积癌症发生率为 13.1%（12.8%-13.5%），非 AAA-CVD 患者为 10.1%（9.9%-10.3%），无 CVD 患者为 9.6%（9.3%-9.9%）。多变量调整后的 Cox 比例风险回归模型发现，与非 AAA-CVD 患者（风险比，1.28 [95%CI，1.23-1.32]；<0.001）或无 CVD 患者（风险比，1.32 [95%CI，1.26-1.38]；<0.001）相比，AAA 患者的癌症风险更高。排除常见的与吸烟相关的癌症后，以及在调整吸烟和体重指数后，结果仍然一致。
AAA 患者可能具有独特的癌症风险，需要进一步进行发病机制研究和探讨强化癌症筛查的作用。
