“Cardiac remodeling” detected by MRI has been linked to an increased risk of breast and colorectal cancer years before diagnosis.
A new study led by University of California Health (California, USA) Doctors and scientists suggest that subtle changes in the structure and function of the heart may indicate an increased risk of developing some types of cancer years later.
Results published in Journal of the American Heart AssociationIt could ultimately help doctors identify patients who may benefit from earlier prevention strategies targeting cardiovascular disease and cancer.
“This study suggests that structural and functional changes in the heart may occur alongside — or even before — biological processes associated with cancer development,” said Dr. Xinjiang Cai, a cardiologist and physician-scientist at UCLA, and lead author of the study. “It adds to the growing evidence that these two diseases share fundamental and intertwined biological pathways.”
Tsai and colleagues analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA), a long-term US study of more than 6,000 adults aged 45 to 84 years with no known cardiovascular disease, recruited from six urban centers between 2000 and 2002.
The group included participants from four racial and ethnic groups: non-Hispanic whites, blacks, Hispanic/Latino Americans, and Chinese Americans.
Researchers assessed basic heart structure and function using cardiac MRI at enrollment and participants were followed for cancer development over an average of 18 years.
They also used multivariate statistical models to investigate the association of cardiac MRI measurements with the risk of all types of cancer, including prostate, breast, colorectal, and lung cancer.
Their findings included several key takeaways:
- People with small, early changes in the structure and function of their heart – a process known as cardiac remodeling – may be at greater risk of developing cancer in the future.
- Increased heart muscle mass was associated with an increased risk of breast cancer.
- Decreased left atrial function was associated with an increased risk of colorectal cancer.
The strongest association concerns left ventricular mass and breast cancer. After adjusting for traditional risk factors for cardiovascular disease and cancer, the researchers found that a higher left ventricular mass index was associated with an increased risk of breast cancer.
They also found that lower peak left atrial strain, a measure of the left atrium’s ability to contract and function, was a strong predictor of colorectal cancer risk. Participants with better left atrial pressure measurements had a significantly lower incidence of colorectal cancer.
During the follow-up period, 790 new cancer cases were identified, including breast, colorectal, lung and prostate cancer. Among participants with available cardiac MRI data, cancer incidence increased as measures of cardiac remodeling worsened.
The researchers stressed that the study does not prove that cardiac remodeling causes cancer, pointing to the limitations of group observational studies. “These results represent correlations and do not prove causation,” Kay explained. “The results do not mean that higher left ventricular mass directly promotes breast cancer or that better atrial function directly prevents colorectal cancer.”
He added that although the researchers took into account many traditional risk factors, other unknown or unmeasurable factors may have influenced the results. There may be detection bias in the study. The results need to be confirmed in additional large population-based studies using cardiac imaging data.
However, this study builds on previous research by Kay and his collaborators, as well as other researchers, showing that higher heart biomarkers and coronary artery calcium scores were also associated with future cancer risk. Unlike previous studies, the new analysis used advanced cardiac MRI to directly measure subtle structural and functional changes in the heart before the disease becomes clinically evident.
The researchers said the findings support a broader, more integrated approach to prevention. They suggest that the findings could ultimately impact how doctors think about cardiovascular disease and cancer prevention strategies. Current guidelines for preventing heart failure already recommend aggressive management of blood pressure, obesity, diabetes and other risk factors in people with early heart disease. The new findings suggest that those same interventions may also have implications for cancer prevention.
“Early cardiac remodeling may serve as an early marker to identify individuals at risk for cardiovascular disease and cancer,” said Kay, who is also a member of the UCLA Johnson Comprehensive Cancer Center. “Our study suggests that imaging markers already used to identify people at risk of cardiovascular disease, including heart failure, may also help identify people at risk of cancer.”
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