Bidirectional Association Between Cardiovascular Disease and Lung Cancer in a Prospective Cohort Study

Cancer risk subsequent to cardiovascular disease: a prospective population-based study and meta-analysis

BACKGROUND

Previous preclinical studies have revealed the biological links between cardiovascular diseases (CVD) and cancer. However, population-based evidence remained inconclusive.

METHODS

We assessed cancer incidence among individuals with and without CVD condition in a prospective cohort from the UK Biobank (UKB). Multivariable Cox regression and competing risk models were fitted to estimate hazard ratios (HR). A systematic literature search was conducted in Medline, Embase and Cochrane Library databases to identify published population-based cohort studies (last updated on 1 October 2023) investigating the associations between CVD status and subsequent cancer risk. Random-effects meta-analysis was employed to pool relative effect estimates reported by eligible cohorts. Subgroup and sensitivity analyses were conducted to evaluate the associations across various CVD and cancer subtypes.

RESULTS

For the cohort study in the UKB, after a median follow-up of 11.58 years, a total of 18,471 and 66,891 cancer cases occurred among 94,845 CVD patients and 368,695 non-CVD individuals (Incidence rate: 25.62 vs. 15.41 per 1000 person-years). Individuals with prior CVD exhibited higher overall cancer risk (HR 1.14, 95% CI 1.12-1.17, p < 0.001), and we observed consistently higher cancer risk after adjusting for competing risk from non-cancer deaths. The effect size of CVD on cancer risk was greater among younger individuals (< 65 years) than those ≥ 65 years (p for interaction < 0.001). The meta-analysis included 47 population-based cohort studies where a total of 1.49 million cancer cases were documented among over 45 million participants (9.49 million CVD patients). A 13% higher risk of overall cancer was observed among individuals with prior CVD (pooled RR 1.13, 95% CI 1.11-1.15, p < 0.001). The associations remained significant between various CVD subtypes and cancer risk at multiple sites.

CONCLUSIONS

Our study identified a significantly higher cancer risk among individuals with CVD conditions compared with the non-CVD population, underpinning the need for continued cancer surveillance among CVD patients and further exploration of the possible etiological relation between CVD and cancer.

Trends and regional variations in chronic ischemic heart disease and lung cancer-related mortality among American adults: Insights from retrospective CDC wonder analysis

Introduction

Lung cancer remains the leading cause of cancer-related mortality in the United States and shares cardiovascular risk factors with chronic ischemic heart disease (CIHD). However, the cumulative mortality burden of these comorbid conditions is underexplored. This study aims to retrospectively assess mortality trends among American adults with concurrent lung cancer and CIHD.

Methods

We utilized death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, encompassing ICD-10 codes for individuals aged ≥45 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population, annual percentage change (APC), and corresponding 95 % confidence intervals (CIs) were calculated. Data were further stratified by year, sex, race, and geographic region (state, rural-urban, and census regions).

Results

A total of 214,785 deaths were identified in adults aged ≥45 years with comorbid lung cancer and CIHD. The overall AAMR between 1999 and 2020 was 8.4 per 100,000 (95 % CI: 8.3 to 8.4). AAMRs remained relatively stable from 1999 to 2005 (APC: -0.84 %; 95 % CI: -1.91 to 1.54), followed by a significant decline from 2005 to 2010 (APC: -2.37 %; 95 % CI: -5.58 to -0.61) and from 2010 to 2017 (APC: -4.72 %; 95 % CI: -7.61 to -3.60). A subsequent period of stability was noted between 2017 and 2020 (APC: 0.86 %; 95 % CI: -2.17 to 5.22). In 1999, men had a threefold higher mortality rate compared to women (AAMR: 17.8 vs. 5.7), with a non-significant decline by 2020 (AAMR: 10 vs. 4). Stratification by race/ethnicity revealed that non-Hispanic (NH) Whites exhibited the highest AAMR at 9.3, followed by NH American Indian or Alaska Natives (7.3), NH Blacks (6.8), Hispanic/Latinos (3.3), and NH Asians or Pacific Islanders (3.2). Geographically, AAMRs were highest in the Midwest (9.6), followed by the Northeast (8.8), South (8.4), and West (6.8). Non-metropolitan regions exhibited higher AAMRs compared to metropolitan areas (10.3 vs. 8.0). States in the top 90th percentile, such as West Virginia, Kentucky, Vermont, Ohio, and Rhode Island, had nearly triple the AAMRs compared to states in the lower 10th percentile, including Utah, Nevada, Arizona, New Mexico, and Hawaii.

Conclusions

From 1999 to 2020, mortality rates for adults aged ≥45 years with concurrent lung cancer and CIHD declined. The highest AAMRs were observed among men, NH Whites, individuals residing in the Midwest, and non-metropolitan populations. This highlights the need for a more comprehensive and tailored approach to managing these patients moving forward.

Association of cardiovascular disease on cancer: observational and mendelian randomization analyses

Extensive research is needed to examine the association between cardiovascular disease (CVD) and cancer. The observational study is based on data collected from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). To assess the connection between CVDs and cancer, we used a weighted multivariable logistic regression analysis with as many confounding factors as feasible included in the model. By employing Mendelian randomization (MR), the unbiased causal relationship between CVDs and cancers was ascertained. The primary analytical approach employed the Inverse Variance Weighted methodology. In cross-sectional study, a positive correlation was observed between CVD and cancer (Model 3, Odds ratio 1.26, 95% confidence interval 1.01 ~ 1.57, p = 0.040). However, MR analysis indicated a negative causal relationship between certain subtypes of CVD and specific cancers, with effect sizes for coronary heart disease and lung cancer (β = - 4.759, p = 0.002), breast cancer (β = - 2.684, p = 0.026), colorectal cancer (β = - 4.581, p = 0.042), liver cancers (β = - 19.264, p = 0.028), and stroke with prostate cancer (β = - 0.299, p = 0.017), with no evidence of a positive correlation. Results from the reverse MR causal analysis revealed a positive correlation between prostate cancer and angina pectoris. An observational study linked CVDs risk to cancer risk. MR analysis has shown that the expected incidence of CVDs can reduce the probability of developing certain forms of cancer. Further investigation is required to examine the clinical correlations and underlying processes between these two illnesses.

Relationship Between Mitochondrial Biological Function and Breast Cancer: An Approach Based on Mendelian Randomization Analysis

Objective: This study aims to investigate the potential causal link between mitochondrial function and breast cancer using the Mendelian randomization (MR) analysis. Methods: The data used for this study were obtained from genomewide association studies (GWAS) databases on mitochondrial biological function and breast cancer. Mitochondrial function was considered the exposure variable, breast cancer the outcome variable, and specific single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs). Two MR methods, inverse variance weighting (IVW) and MR-Egger regression, were used to assess the causal association between mitochondrial function and breast cancer. Data analysis and visualization were performed using R software. Results: The results of the analysis revealed that several genes, including 39S ribosomal protein L34, pyruvate carboxylase, rRNA methyltransferase 3, and cytochrome c oxidase assembly factor 3 homolog, are causally linked to an increased risk of breast cancer in European populations. In addition, cytochrome c oxidase subunit 8A and ADP-ribose pyrophosphatase were found to be protective factors against breast cancer in European populations. In East Asian populations, 39S ribosomal protein L52, ATP synthase subunit beta, and pyruvate dehydrogenase (acetyl-transferring) were identified as causal risk factors for breast cancer. Conversely, 39S ribosomal protein L32, ADP-ribose pyrophosphatase, and cytochrome c oxidase subunit 8A were identified as protective factors against breast cancer in this population. Conclusion: In conclusion, this study provides evidence of a causal relationship between mitochondrial function and breast cancer in both European and East Asian populations. Additional research is warranted to further elucidate the mechanisms underlying this association.

Association of Cardiovascular Risk Factors and Coronary Calcium Burden with Epicardial Adipose Tissue Volume Obtained from PET-CT Imaging in Oncological Patients

Whole-body positron emission tomography (PET)-computed tomography (CT) imaging performed for oncological purposes may provide additional parameters such as the coronary artery calcium (CAC) and epicardial adipose tissue (EAT) volume with cost-effective prognostic information in asymptomatic people beyond traditional cardiovascular risk factors. We evaluated the feasibility of measuring the CAC score and EAT volume in cancer patients without known coronary artery disease (CAD) referred to whole-body 18F-FDG PET-CT imaging, regardless of the main clinical problem. We also investigated the potential relationships between traditional cardiovascular risk factors and CAC with EAT volume. A total of 109 oncological patients without overt CAD underwent whole-body PET-CT imaging with 18F-fluorodeoxyglucose (FDG). Unenhanced CT images were retrospectively viewed for CAC and EAT measurements on a dedicated platform. Overall, the mean EAT volume was 99 ± 49 cm3. Patients with a CAC score ≥ 1 were older than those with a CAC = 0 (p < 0.001) and the prevalence of hypertension was higher in patients with detectable CAC as compared to those without (p < 0.005). The EAT volume was higher in patients with CAC than in those without (p < 0.001). For univariable age, body mass index (BMI), hypertension, and CAC were associated with increasing EAT values (all p < 0.005). However, the correlation between the CAC score and EAT volume was weak, and in multivariable analysis only age and BMI were independently associated with increased EAT (both p < 0.001), suggesting that potential prognostic information on CAC and EAT is not redundant. This study demonstrates the feasibility of a cost-effective assessment of CAC scores and EAT volumes in oncological patients undergoing whole-body 18F-FDG PET-CT imaging, enabling staging cancer disease and atherosclerotic burden by a single test already included in the diagnostic work program, with optimization of the radiation dose and without additional costs.

An Automated Clubbed Fingers Detection System Based on YOLOv8 and U-Net: A Tool for Early Prediction of Lung and Cardiovascular Diseases

Background/Objectives: Lung and cardiovascular diseases are leading causes of mortality worldwide, yet early detection remains challenging due to the subtle symptoms. Digital clubbing, characterized by the bulbous enlargement of the fingertips, serves as an early indicator of these diseases. This study aims to develop an automated system for detecting digital clubbing using deep-learning models for real-time monitoring and early intervention. Methods: The proposed system utilizes the YOLOv8 model for object detection and U-Net for image segmentation, integrated with the ESP32-CAM development board to capture and analyze finger images. The severity of digital clubbing is determined using a custom algorithm based on the Lovibond angle theory, categorizing the condition into normal, mild, moderate, and severe. The system was evaluated using 1768 images and achieved cloud-based and real-time processing capabilities. Results: The system demonstrated high accuracy (98.34%) in real-time detection with precision (98.22%), sensitivity (99.48%), and specificity (98.22%). Cloud-based processing achieved slightly lower but robust results, with an accuracy of 96.38%. The average processing time was 0.15 s per image, showcasing its real-time potential. Conclusions: This automated system provides a scalable and cost-effective solution for the early detection of digital clubbing, enabling timely intervention for lung and cardiovascular diseases. Its high accuracy and real-time capabilities make it suitable for both clinical and home-based health monitoring.

Cardiovascular health and cancer mortality: evidence from US NHANES and UK Biobank cohort studies

BACKGROUND

The American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk remains uncertain.

METHODS

We investigated 17,076 participants from US National Health and Nutrition Examination Survey (US NHANES) and 272,727 participants from UK Biobank, all free of cancer at baseline. The CVH score, based on LE8 metrics, incorporates four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index, lipid, blood glucose, and blood pressure). Self-reported questionnaires assessed health behaviors. Primary outcomes were mortality rates for total cancer and its subtypes. The association between CVH score (continuous and categorical variable) and outcomes was examined using Cox model with adjustments. Cancer subtypes-related polygenic risk score (PRS) was constructed to evaluate its interactions with CVH on cancer death risk.

RESULTS

Over 141,526 person-years in US NHANES, 424 cancer-related deaths occurred, and in UK Biobank, 8,872 cancer deaths were documented during 3,690,893 person-years. High CVH was associated with reduced overall cancer mortality compared to low CVH (HR 0.58, 95% CI 0.37-0.91 in US NHANES; 0.51, 0.46-0.57 in UK Biobank). Each one-standard deviation increase in CVH score was linked to a 19% decrease in cancer mortality (HR: 0.81; 95% CI: 0.73-0.91) in US NHANES and a 19% decrease (HR: 0.81; 95% CI: 0.79-0.83) in UK Biobank. Adhering to ideal CVH was linearly associated with decreased risks of death from lung, bladder, liver, kidney, esophageal, breast, colorectal, pancreatic, and gastric cancers in UK Biobank. Furthermore, integrating genetic data revealed individuals with low PRS and high CVH exhibited the lowest mortality from eight cancers (HRs ranged from 0.36 to 0.57) compared to those with high PRS and low CVH. No significant modification of the association between CVH and mortality risk for eight cancers by genetic predisposition was observed. Subgroup analyses showed a more pronounced protective association for overall cancer mortality among younger participants and those with lower socio-economic status.

CONCLUSIONS

Maintaining optimal CVH is associated with a substantial reduction in the risk of overall cancer mortality. Adherence to ideal CVH correlates linearly with decreased mortality risk across multiple cancer subtypes. Individuals with both ideal CVH and high genetic predisposition demonstrated significant health benefits. These findings support adopting ideal CVH as an intervention strategy to mitigate cancer mortality risk and promote healthy aging.

The association of maternal smoking around birth with chronic respiratory diseases in adult offspring: A Mendelian randomization study

INTRODUCTION

Maternal smoking during pregnancy disturbs fetal lung development, and induces in their offspring childhood respiratory diseases. Whether it has a continued impact on offspring adult lung health and exerts a casual effect of chronic respiratory diseases (CRDs), remains uncertain. We seek to determine the causal relationships between maternal smoking around birth and offspring adult CRDs, using summary data from previously described cohorts.

METHODS

Mendelian randomization (MR) study was used to analyze the genome-wide associations of maternal smoking around birth and offspring adult CRDs, including respiratory insufficiency, chronic obstructive pulmonary disease (COPD), related respiratory insufficiency, emphysema, COPD, COPD hospital admissions, early onset of COPD, later onset of COPD, asthma, idiopathic pulmonary fibrosis (IPF), lung cancer (LC), small cell lung carcinoma (SCLC), and lung squamous cell carcinoma (LUSC).

RESULTS

After removing single-nucleotide polymorphisms (SNPs) associated with smoking by the offspring, maternal smoking around birth was associated with increased risk of offspring adult respiratory diseases (OR=1.14; 95% CI: 1.013-1.284; p=0.030), respiratory insufficiency (OR=2.413; 95% CI: 1.039-5.603; p=0.040), COPD (OR=1.14; 95% CI: 1.013-1.284; p=0.003), and asthma (OR=1.336; 95% CI: 1.161-1.538; p<0.001). Besides, maternal smoking during pregnancy was associated with a greater risk of LUSC (OR=1.229; 95% CI: 0.992-1.523; p=0.059) than the risk of IPF (OR=1.001; 95% CI: 0.999-1.003; p=0.224), LC (OR=1.203; 95% CI: 0.964-1.501; p=0.103), or SCLC (OR=1.11; 95% CI: 0.77-1.601; p=0.577).

CONCLUSIONS

In this MR analysis, maternal smoking around birth caused a strong risk factor for the offspring to develop lung problems and CRDs in adulthood. The policy related to smoking cessation for mothers during pregnancy should be encouraged.