Cardiovascular disease is linked to a higher risk of lung cancer

~~Context~~

Various epidemiological studies suggest a link between cardiovascular disease (CVD) and the development of lung cancers, but have methodological flaws.

Conclusions

A new, more rigorous study indicates that CVDs are associated with a 67% higher risk of lung cancer and a 95% higher risk of lung cancer death.The study is a nationally paired cohort study conducted in Denmark.
The prospective population cohort study followed patients with CVD for up to 42 years.
The increased risk of lung cancer was greatest in CVD diagnosed in middle adulthood (age>40 years).

Why it matters

The mechanism underlying the association between CVD and lung cancer is unknown, but may involve chronic CVD-induced inflammation. Chronic inflammation is known to promote the development of cancer over time.
The authors of the new study encourage primary care physicians to evaluate lung cancer screening for newly diagnosed CVDs in mid-adulthood, the age at which lung cancer risk is highest.

Study design

Nationally paired, prospective, population cohort study of all patients newly diagnosed with CVD (n=306,285) matched by sex and age to 4 control participants without CVD (n=1,222,140) in Denmark.
The new cases of CVD came from the Danish National Patient Registry (period 1967–2006).These subjects were considered the «exposed» cohort, while the paired control participants were considered the «unexposed» cohort.
The primary outcomes were lung cancer incidence and lung cancer mortality according to the Danish Cancer Registry and the Danish Cause of Death Registry.
Results were corrected for potential confounding factors, including obesity, diabetes mellitus, smoking, alcohol-related disorders, cohabitation and educational attainment.
Funding: Independent Research Fund Denmark; Nordic Cancer Union; other.

Main results

Follow-up lasted 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 unexposed participants developed lung cancer at a rate of 0.04%.
After adjusting for confounders, the difference in rates resulted in a 67% higher risk of lung cancer in exposed participants compared to those not exposed (adjusted hazard ratio [aHR]=1.67; 95% CI, 1.42–1.96).The confidence interval is the range of values within which HR falls with only a 5% probability of being wrong.
The risk was even higher for mortality. Exposed participants had a 95% increased risk of lung cancer mortality compared to unexposed participants (aHR=1.95; 95% CI, 1.50–2.55).
The association between CVD and lung cancer incidence was evident in 3 major CVD subtypes:
- for heart disease, the risk was increased by 93% (aHR=1.93; 95% CI, 1.30–2.85);
- for vascular disease, the risk was increased by 88% (aHR=1.88; 95% CI, 1.35–2.61);
- for hypertensive disease the risk was increased by 46% (aHR=1.46; 95% CI, 1.15–1.85).
The incidence and mortality of lung cancer appeared to increase with increasing age at diagnosis of CVD.The older 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) in exposed participants compared to those not exposed.

for heart disease, the risk was increased by 93% (aHR=1.93; 95% CI, 1.30–2.85);
for vascular disease, the risk was increased by 88% (aHR=1.88; 95% CI, 1.35–2.61);
for hypertensive disease the risk was increased by 46% (aHR=1.46; 95% CI, 1.15–1.85).

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