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Microvascular endothelial dysfunction confers twofold increase in cancer risk
Microvascular endothelial dysfunction may serve as a marker for cancer, as patients with the condition had elevated risk for solid-tumor cancer, according to a study published in the European Journal of Preventive Cardiology.
“Cardiologists should focus on addressing the risk factors for endothelial dysfunction, early disease and vascular injury with modification of lifestyle, which actually has a common mechanism for cardiovascular disease and cancers,” Amir Lerman, MD, consultant in the division of ischemic heart disease and critical care in the department of cardiovascular medicine and director of the cardiovascular research center at Mayo Clinic, told Healio.
Takumi Toya, MD, of the department of cardiovascular medicine at Mayo Clinic and the division of cardiology at the National Defense Medical College in Tokorozawa, Japan, and colleagues analyzed data from 488 patients (mean age, 54 years; 60% women) without a known hematological malignancy who underwent microvascular endothelial dysfunction assessment between January 2006 and February 2014. Assessment was performed with reactive hyperemia peripheral arterial tonometry. For this study, a reactive hyperemia peripheral arterial tonometry index of less than 2 was an indication of microvascular endothelial dysfunction.
Other data were obtained from detailed chart review such as age, sex, BMI, traditional CVD risk factors, dyslipidemia, type 2 diabetes, hypertension, CAD and a solid-tumor cancer diagnosis before and after the baseline test.
There were 221 patients who had microvascular endothelial dysfunction, of whom 9.5% were diagnosed with solid-tumor cancer during follow-up, compared with 3.7% of the 267 patients without microvascular endothelial dysfunction (P = .009).
During a median follow-up of 6 years, patients with microvascular endothelial dysfunction had lower solid-tumor cancer-free survival vs. those without microvascular endothelial dysfunction (log-rank P = .017).
“There are implications, but it’s not ready to be translated to clinical practice yet,” Lerman said in an interview. “It gives you a barometer or marker for ongoing abnormalities, systemic inflammation or ongoing risk, and gives you a glimpse or an opportunity to say, ‘Something is not going correctly. We need to investigate other factors that may lead to both cardiovascular disease and cancer.’”
In Cox proportional hazard analyses, microvascular endothelial dysfunction predicted the incidence of solid-tumor cancer after the following adjustments:
- Sex, age and CAD (HR = 2.52; 95% CI, 1.17-5.45);
- Diabetes, smoking status, hypertension and BMI greater than 30 kg/m2 (HR = 2.83; 95% CI, 1.3-6.17);
- Systolic BP, fasting plasma glucose, BMI and either current or former smoking status (HR = 2.79; 95% CI, 1.21-6.41); and
- Framingham risk score (HR = 2.43; 95% CI, 1.1-5.34).
“One of the issues with this study is because it was not big enough, you cannot actually talk about specific cancers such as breast cancer, colon cancer,” Lerman told Healio. “You need more patients to identify this, so we need to increase the data. It probably should be extended to other populations, not only the population that we are studying. There’s a lot of things to do and [to] collate it with other biomarkers of inflammation and biomarkers of cancer.” – by Darlene Dobkowski
For more information:
Amir Lerman, MD, can be reached at 200 First Street SW, Rochester, MN 55905; email: lerman.amir@mayo.edu.
Disclosures: Lerman reports he consults for Itamar Medical. The other authors report no relevant financial disclosures.