News | Cardio-oncology | December 21, 2018

Heart Attack, Stroke Risks Increase Leading Up to Cancer Diagnosis

Risk greatest in people with later-stage cancers and lung and colon cancers

Heart Attack, Stroke Risks Increase Leading Up to Cancer Diagnosis

December 21, 2018 — Older adults with cancer are more likely to have had a heart attack or stroke in the months prior to their cancer diagnosis, according to a report published online in Blood. The study compared this group with similar adults who do not have cancer during the same period. Lung and colon cancers, as well as advanced-staged cancers, appear to be most strongly associated with an elevated risk of heart attack and stroke caused by blood clots in the arteries.

The study is the largest and most systematic evaluation of these events leading up to a cancer diagnosis, according to researchers at Weill Cornell Medicine, NewYork-Presbyterian, and Memorial Sloan Kettering Cancer Center in New York City.

"Our data show there is an associated risk of ischemic stroke and heart attack that begins to increase in the five months before the cancer is officially diagnosed and peaks in the month just before," said lead study author Babak Navi, M.D., MS, an associate professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. "These results suggest that cancer's effect on the clotting system may be what's predominantly driving the associated risk of heart attacks and stroke."

Cancers can take months and sometimes years to develop and be diagnosed, and some cancers may be exerting biological effects on the body, especially thromboembolic activity, before they come to medical attention, he explained.

Researchers used information from a Medicare database linked to the Surveillance, Epidemiology, and End Results (SEER) registry. They retrospectively looked at the risk of heart attack and stroke in people 67 years and older who were newly diagnosed with breast, lung, prostate, colorectal, bladder, non-Hodgkin lymphoma, uterine, pancreatic, and gastric cancers from Jan. 1, 2005, to Dece. 31, 2013. Together, these cancers account for two-thirds of all cancer diagnoses in the United States. The study included 748,662 Medicare beneficiaries and compared patients with cancer to matched controls during the 360 days before the cancer diagnosis.

Overall, the risk of having a heart attack and stroke jumped by 70 percent in the year before cancer diagnosis. The risk was most acute in the month immediately before cancer diagnosis. During this time, patients who were later diagnosed with cancer were more than five times more likely to have a heart attack or stroke compared with those who did not have cancer – 2,313 of cancer patients had an event compared with 413 of matched controls. Beyond five months before a cancer diagnosis, the risks of these events were similar in both groups. The rate of heart attack or stroke was highest in adults with lung and colorectal cancers and those with stage 3 or 4 disease. When analyzed separately, both heart attack and stroke risk were increased in the months before cancer diagnosis, although heart attack events were slightly more common than strokes. Secondary analyses of additional arterial thromboembolic event types (i.e., thromboembolism of arteries supplying the peripheral limbs or mesentery) further substantiated the primary findings.

The data confirm the association of heart attack and stroke with cancer development and delineate when the risk starts and its relative magnitude, said Navi, who is also chief of the Division of Stroke and Hospital Neurology in the Department of Neurology at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell.

"Our findings suggest that cancer could be a risk factor for arterial thromboembolism, so people who have a heart attack or stroke should be up-to-date with their age- and gender-specific cancer screenings, such as mammograms and colonoscopies," Navi added. "If someone has a heart attack or stroke and there are any concerning signs for an undiagnosed malignancy, such as weight loss or unexplained anemia, then perhaps a cancer screening should be considered."

Navi and his team are planning future research studies to better understand what blood or imaging biomarkers could serve as clues to occult cancer in patients with arterial thromboembolism, as well as what the utility of body computed tomography (CT) imaging or other cancer screening tools might be in these patients, particularly in those whose strokes or heart attacks are otherwise unexplained. Navi also stressed that more investigations are needed to determine the exact cause of arterial thromboembolism in patients with cancer and the optimal strategies to prevent and treat these events.

The use of claims data did not allow the researchers to account for lifestyle factors, such as smoking status, event severity or how interruptions in blood thinning therapies prior to surgical procedures may have played a role. As well, some of the events could have led to a cancer diagnosis because of increased medical surveillance and testing.

This study was funded by the National Institutes of Health.

For more information: www.bloodjournal.org

Reference

1. Navi B.B., Reiner A.S., Kamel H., et al. Arterial thromboembolic events preceding the diagnosis of cancer in older persons. Blood, Dec. 21, 2018. https://doi.org/10.1182/blood-2018-06-860874

Related Content

An example of a HeartFlow FFR-CT image showing the blood flow through what looked like a significant blockage on CT angiography alone, actually was not flow-limiting based on computational fluid dynamics. Use of the technology was supposed to reduce the number of diagnostic catheterizations in the FORECAST trial, but the costs of FFR-CT were not offset enough to show cost savings.

An example of a HeartFlow FFR-CT image showing the blood flow through what looked like a significant blockage on CT angiography alone, actually was not flow-limiting based on computational fluid dynamics. Use of the technology was supposed to reduce the number of diagnostic catheterizations in the FORECAST trial, but the costs of FFR-CT were not offset enough to show cost savings.

Feature | CT Angiography (CTA) | October 23, 2020
October 22, 2020 – In the FORECAST randomized clinical trial, the use of ...
This illustration show the complexity of the data obtained from one single patient with moderate/severe traumatic brain injury. Different imaging approaches and techniques have their own unique sensitivity in assessing different aspects of neuroanatomy and neuropathology. What can be seen on images also changes with time since injury. Data from comprehensive clinical and functional assessments using a range of other tools is also important for evaluating patient outcome. Through data harmonization and large

This illustration show the complexity of the data obtained from one single patient with moderate/severe traumatic brain injury. Different imaging approaches and techniques have their own unique sensitivity in assessing different aspects of neuroanatomy and neuropathology. What can be seen on images also changes with time since injury. Data from comprehensive clinical and functional assessments using a range of other tools is also important for evaluating patient outcome. Through data harmonization and large-scale analyses of data combined across multiple research sites, the ENIGMA Brain Injury will develop and test methods and procedures for making sense of the complexity in this data. Images courtesy of Olsen et al., Brain Imaging and Behavior, 2020

News | Magnetic Resonance Imaging (MRI) | October 23, 2020
October 23, 2020 — Trau...
The fMRI hyperscanning environment.

(A) The fMRI hyperscanning environment. The clinician (1) and patient (2) were positioned in two different 3T MRI scanners. An audio-video link enabled online communication between the two scanners (3), and video images were used to extract frame-by-frame facial expression metrics. During simultaneous acquisition of blood oxygen level–dependent (BOLD)–fMRI data, the clinician used a button box (4) to apply electroacupuncture (EA) treatment (real/sham, double-blind) to the patient (5) to alleviate evoked pressure pain to the leg (6; Hokanson cuff inflation). Pain and affect related to the treatment were rated after each trial. (B) Study overview. After an initial behavioral visit, each individual participated in a Clinical-Interaction (hyperscan preceded by a clinical intake) and No-Interaction condition (hyperscan without a preceding intake), in a counterbalanced order, with two different partners. (C) Experimental protocol. Each hyperscan was composed of 12 repeated trials (four verum EA, four sham EA, and four no treatment) in a pseudo-randomized order. After a resting period (far left), both participants were shown a visual cue to indicate whether the next pain stimulus would be treated (green frame) or not treated (red frame) by the clinician. These cues prompted clinicians prepare to either apply or not apply treatment while evoking corresponding anticipation for the patient. Following the anticipation cue, moderately painful pressure pain was applied to the patient’s left leg, while the clinician applied or did not apply treatment, respectively. After another resting period, participants rated pain (patients), vicarious pain (clinicians), and affect (both) using a visual analog scale (VAS).

News | Clinical Trials | October 22, 2020
October 22, 2020 — The potential impact of the patient-clinician relationship on a patient's response to treatment is
Lesion was originally reported as indeterminate enhancing mass, and outside report recommended biopsy. Classic features of benign hemangioma are shown. Error was attributed to faulty reasoning. A, Axial MR image obtained 5 minutes after contrast agent administration shows peripheral nodular discontinuous enhancement. B, Axial MR image obtained 10 minutes after contrast agent administration shows centripetal progression of enhancement (arrow). C, Axial fast imaging employing steady-state acquisition (FIESTA)

Lesion was originally reported as indeterminate enhancing mass, and outside report recommended biopsy. Classic features of benign hemangioma are shown. Error was attributed to faulty reasoning. A, Axial MR image obtained 5 minutes after contrast agent administration shows peripheral nodular discontinuous enhancement. B, Axial MR image obtained 10 minutes after contrast agent administration shows centripetal progression of enhancement (arrow). C, Axial fast imaging employing steady-state acquisition (FIESTA) MR image shows lesion is homogeneously hyperintense compared with liver parenchyma. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | Magnetic Resonance Imaging (MRI) | October 21, 2020
October 21, 2020 — According to an artic...
Conducted by the University of Gothenburg, Lund University and the University of South Australia, the preclinical study found that dietary oat bran can offset chronic gastrointestinal damage caused by radiotherapy, contradicting long-held clinical recommendations.

Getty Images

News | Radiation Therapy | October 07, 2020
October 7, 2020 — Loved or hated, the humble oat could be the new superfood for cancer patients as international ...
A, Sagittal reformatted bone window CT image of thoracic spine shows wedge-shaped deformity at T6 and subtle superior endplate deformities at T5 and T8. Arrows denote deformities. B, Color-coded dual-energy CT shows only T8 deformity is associated with bone marrow edema; T5 and T6 deformities likely represent chronic fractures. Arrows denote deformities.

A, Sagittal reformatted bone window CT image of thoracic spine shows wedge-shaped deformity at T6 and subtle superior endplate deformities at T5 and T8. Arrows denote deformities. B, Color-coded dual-energy CT shows only T8 deformity is associated with bone marrow edema; T5 and T6 deformities likely represent chronic fractures. Arrows denote deformities.

News | Computed Tomography (CT) | October 06, 2020
These MRI scans show diffuse white matter abnormality (DWMA). The top three panels display raw MRI images from very preterm infants born at 27 weeks (left), 26 weeks (center) and 31 weeks (right) gestation.

These MRI scans show diffuse white matter abnormality (DWMA). The top three panels display raw MRI images from very preterm infants born at 27 weeks (left), 26 weeks (center) and 31 weeks (right) gestation. Higher signal intensity can be seen in the central white matter, particularly for the 31-week gestation infant. The bottom panels display the corresponding slices with objectively segmented DWMA in yellow. The 27-week infant (left) was diagnosed with mild DWMA, the 26-week infant (center) was diagnosed with moderate DWMA, and the 31-week infant had severe DWMA. Image courtesy of Cincinnati Children's and Nature Scientific Reports

News | Magnetic Resonance Imaging (MRI) | October 01, 2020
October 1, 2020 — As many as 70% of very premature infants (born earlier than 32 weeks gestation) show signs of white
Newly released study results present a strong case for lung cancer screening in New Zealand — particularly for Māori whose mortality rates are between three and four times higher than other ethnic groups.

Image courtesy of Siemens Healthineers

News | Lung Imaging | September 30, 2020
September 30, 2020 — Newly released study results present a strong case for...