TY - JOUR
T1 - The relation between systemic inflammation and incident cancer in patients with stable cardiovascular disease
T2 - a cohort study
AU - Van't Klooster, Cilie C
AU - Ridker, Paul M
AU - Hjortnaes, Jesper
AU - van der Graaf, Yolanda
AU - Asselbergs, Folkert W
AU - Westerink, Jan
AU - Aerts, Joachim G J V
AU - Visseren, Frank L J
N1 - Funding Information:
Conflict of interest: P.M.R. served as the Principle Investigator of CANTOS and CIRT, funded by Novartis and the NHLBI, respectively. P.M.R. is listed as a co-inventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease and has served as a consultant to Novartis, Merck, Amgen, Corvidia, and Inflazome. F.W.A. is supported by UCL Hospitals NIHR Biomedical Research Centre. J.G.J.V.A. has served as a consultant for Eli-Lilly, MSD, BMS, Boehringer Ingelheim, Amphera, Astra-Zeneca, Takeda, and Roche and is stock owner of Amphera. All other authors have no conflict of interest to declare.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/12/21
Y1 - 2019/12/21
N2 - AIMS: Low-grade inflammation, measured by elevated plasma concentrations of high-sensitive C-reactive protein (CRP), is a risk factor for cardiovascular disease (CVD). There is evidence that low-grade inflammation is also related to a higher risk of cancer. The present prospective cohort study evaluates the relation between low-grade systemic inflammation and risk of cancer in patients with stable CVD.METHODS AND RESULTS: In total, 7178 patients with stable CVD and plasma CRP levels ≤10 mg/L were included. Data were linked to the Dutch national cancer registry. Cox regression models were fitted to study the relation between CRP and incident CVD and cancer. After a median follow-up time of 8.3 years (interquartile range 4.6-12.3) 1072 incident cancer diagnoses were observed. C-reactive protein concentration was related to total cancer [hazard ratio (HR) 1.35; 95% confidence interval (CI) 1.10-1.65] comparing last quintile to first quintile of CRP. Especially lung cancer, independent of histopathological subtype, was related to CRP (HR 3.39; 95% CI 2.02-5.69 comparing last to first quintile of CRP). Incidence of epithelial neoplasms and especially squamous cell neoplasms were related to CRP concentration, irrespective of anatomical location. Sensitivity analyses after excluding patients with a cancer diagnosis within 1, 2, and 5 years of follow-up showed similar results. No effect modification was observed by smoking status or time since smoking cessation (P-values for interaction > 0.05).CONCLUSION: Chronic systemic low-grade inflammation, measured by CRP levels ≤10 mg/L, is a risk factor for incident cancer, markedly lung cancer, in patients with stable CVD. The relation between inflammation and incident cancer is seen in former and current smokers and is uncertain in never smokers.
AB - AIMS: Low-grade inflammation, measured by elevated plasma concentrations of high-sensitive C-reactive protein (CRP), is a risk factor for cardiovascular disease (CVD). There is evidence that low-grade inflammation is also related to a higher risk of cancer. The present prospective cohort study evaluates the relation between low-grade systemic inflammation and risk of cancer in patients with stable CVD.METHODS AND RESULTS: In total, 7178 patients with stable CVD and plasma CRP levels ≤10 mg/L were included. Data were linked to the Dutch national cancer registry. Cox regression models were fitted to study the relation between CRP and incident CVD and cancer. After a median follow-up time of 8.3 years (interquartile range 4.6-12.3) 1072 incident cancer diagnoses were observed. C-reactive protein concentration was related to total cancer [hazard ratio (HR) 1.35; 95% confidence interval (CI) 1.10-1.65] comparing last quintile to first quintile of CRP. Especially lung cancer, independent of histopathological subtype, was related to CRP (HR 3.39; 95% CI 2.02-5.69 comparing last to first quintile of CRP). Incidence of epithelial neoplasms and especially squamous cell neoplasms were related to CRP concentration, irrespective of anatomical location. Sensitivity analyses after excluding patients with a cancer diagnosis within 1, 2, and 5 years of follow-up showed similar results. No effect modification was observed by smoking status or time since smoking cessation (P-values for interaction > 0.05).CONCLUSION: Chronic systemic low-grade inflammation, measured by CRP levels ≤10 mg/L, is a risk factor for incident cancer, markedly lung cancer, in patients with stable CVD. The relation between inflammation and incident cancer is seen in former and current smokers and is uncertain in never smokers.
KW - Chronic systemic low-grade inflammation
KW - High-sensitive C-reactive protein
KW - Risk factor
KW - Incident cancer
KW - Patients with vascular disease
UR - http://www.scopus.com/inward/record.url?scp=85077017069&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehz587
DO - 10.1093/eurheartj/ehz587
M3 - Article
C2 - 31504409
SN - 0195-668X
VL - 40
SP - 3901
EP - 3909
JO - European Heart Journal
JF - European Heart Journal
IS - 48
ER -