Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Int J Cardiol. 2025 Jan 1;418:132577. doi: 10.1016/j.ijcard.2024.132577. Epub 2024 Sep 19.
Several studies reported an increased cancer risk related to lower-extremity peripheral artery disease (PAD) but had important caveats: not accounting for key confounders like smoking, follow-up <10 years, or no race-specific results. To assess the long-term independent association of PAD with cancer incidence in a bi-racial community-based cohort.
We categorized 13,106 ARIC participants without cancer at baseline (mean age 54.0 [SD 5.7] years, 45.7 % male, and 26.1 % Black) into symptomatic PAD (clinical history or intermittent claudication), asymptomatic PAD (ankle-brachial index [ABI] ≤0.9), and five ABI categories (0.1-interval between 0.9 and 1.3 and > 1.3). We used cancer registries and medical records to ascertain cancer cases and ran multivariable Cox models.
During the median follow-up of 25.3 years, there were 4143 incident cancer cases. 25-year cumulative incidence was 37.2 % in symptomatic PAD, 32.3 % in asymptomatic PAD, and 28.0-31.0 % in the other categories. Symptomatic and asymptomatic PAD remained significantly associated with cancer incidence after adjusting for potential confounders, including smoking and diabetes (hazard ratio [HR] 1.42 [1.05-1.92] and 1.24 [1.05-1.46], respectively). When stratified by smoking status, we observed a robust association of PAD (symptomatic and asymptomatic combined) vs. no PAD with cancer risk in ever smokers (HR 1.42 [1.21-1.67]) but not in never smokers. The results were most evident for lung cancer (HR 2.16 (95 %CI 1.65-2.83) for PAD vs. no PAD within ever smokers).
Symptomatic and asymptomatic PAD conferred cancer risk, particularly among ever smokers and for lung cancer. Patients with PAD should receive evidence-based cancer prevention and screening.
多项研究报告称，下肢外周动脉疾病（PAD）与癌症风险增加有关，但存在重要的局限性：未考虑到吸烟等关键混杂因素、随访时间<10 年或没有针对特定种族的结果。本研究旨在评估在一个双种族基于社区的队列中，PAD 与癌症发病率的长期独立关联。
我们将基线时无癌症的 13106 名 ARIC 参与者（平均年龄 54.0 [SD 5.7] 岁，45.7%为男性，26.1%为黑人）分为有症状 PAD（临床病史或间歇性跛行）、无症状 PAD（踝肱指数 [ABI] ≤0.9）和五个 ABI 类别（0.1-0.9 之间的间隔为 0.1，ABI>1.3）。我们使用癌症登记处和医疗记录来确定癌症病例，并运行多变量 Cox 模型。
在中位数为 25.3 年的随访期间，有 4143 例新发癌症病例。25 年累积发病率在有症状 PAD 为 37.2%，无症状 PAD 为 32.3%，其他类别为 28.0-31.0%。在调整了潜在混杂因素（包括吸烟和糖尿病）后，有症状和无症状 PAD 与癌症发病率仍显著相关（风险比 [HR] 1.42 [1.05-1.92] 和 1.24 [1.05-1.46]）。按吸烟状态分层时，我们观察到 PAD（有症状和无症状合并）与无 PAD 相比，在曾经吸烟者中与癌症风险相关（HR 1.42 [1.21-1.67]），但在从不吸烟者中则不然。这些结果在肺癌中最为明显（HR 2.16 [95%CI 1.65-2.83]，有症状和无症状 PAD 与曾经吸烟者中的无 PAD 相比）。
有症状和无症状 PAD 会增加癌症风险，尤其是在曾经吸烟者和肺癌中。PAD 患者应接受基于证据的癌症预防和筛查。
