Background
- Several epidemiological studies suggested a link between cardiovascular disease (CVD) and the development of lung cancer, but were methodologically deficient.
Insight
- A new, more rigorous study found that CVD is associated with a 67% higher risk of lung cancer and a 95% higher risk of death from lung cancer.The study was a nationwide matched cohort study from Denmark.
- In the population-based prospective cohort study, patients with CVD were followed for up to 42 years.
- The increased risk of lung cancer was highest in CVD cases diagnosed in middle adulthood (age>40 years).
Why this matters
- The mechanism for the link between CVD and lung cancer is unknown, but it may be due to CVD-induced chronic inflammation. It is known that chronic inflammation promotes the development of cancer over time.
- The authors of the new study encourage primary care physicians to consider lung cancer screening for CVD cases newly diagnosed in middle adulthood, the age at highest risk of lung cancer.
Study design
- Population-based, prospective, nationwide, matched cohort study of all newly diagnosed patients with CVD (n=306,285) matched on the basis of sex and age with 4 control participants without CVD (n=1,222,140) in Denmark.
- The new CVD cases came from the Danish National Patient Registry (1967-2006).These subjects were considered as «exposed» cohorts, while the assigned control participants were considered as «unexposed» cohorts.
- Primary endpoints were lung cancer incidence and lung cancer mortality, based on the Danish Cancer Registry and the Danish Causes of Death Register.
- The results were adjusted for potential confounding factors, including obesity, diabetes mellitus, smoking, alcohol problems, cohabitation and education level.
- Funding: Independent Research Fund Denmark; Nordic Cancer Union; other.
Key results
- Follow-up was up to 42 years with a median follow-up of 10.2 years.
- The exposed population developed lung cancer at a rate of 0.08%, while the rate of unexposed participants was 0.04%.
- After adjusting for confounding factors, the difference in rates resulted in a 67% higher risk of lung cancer in exposed versus unexposed participants (aHR 1.67; 95% CI 1.42-1.96).The confidence interval is the range of values between which HR lies with a probability of error of only 5%.
- For mortality, the risk was even higher: the exposed participants had a 95% increased risk of lung cancer mortality compared to the unexposed participants (aHR 1.95; 95% CI 1.50-2.55).
- The association between CVD and lung cancer was found in 3 major subtypes of CVD:
- Heart disease was 93% increased (aHR 1.93; 95% CI 1.30-2.85).
- Vascular disease had an 88% increased risk (aHR 1.88; 95% CI 1.35-2.61).
- Hypertension had a 46% increased risk (aHR 1.46; 95% CI 1.15-1.85).
- Lung cancer incidence and mortality appeared to increase with age at CVD diagnosis. The oldest age group (>40 years) had the highest risk of lung cancer incidence (aHR 3.44; 95% CI 2.28-5.19) and lung cancer mortality (aHR 3.67; 95% CI 1.80-7.46) among exposed versus unexposed participants.
- Heart disease was 93% increased (aHR 1.93; 95% CI 1.30-2.85).
- Vascular disease had an 88% increased risk (aHR 1.88; 95% CI 1.35-2.61).
- Hypertension had a 46% increased risk (aHR 1.46; 95% CI 1.15-1.85).
Restrictions
- Observation design
- Potential residual distortion due to uncontrolled factors.
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Source — https://www.univadis.de/viewarticle/herz-kreislauf-erkrankungen-sind-mit-hoherem-lungenkrebsrisiko-verbunden
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