Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer
ABSTRACT Background Prior studies have documented that patients with colorectal cancer (CRC) are at an increased risk of cardiovascular disease (CVD). Objectives To examine coronary artery calcium (CAC) as a marker of subclinical atherosclerosis and its association with major adverse cardiovascular...
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Wiley
2025-05-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70938 |
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| author | Julia A. Levy Elham Kazemian Cody Ramin Nicole C. Loroña Maimoona Nadri Jordan O. Gasho Katrina D. Silos Andriana P. Nikolova Damini Dey Erin M. Siegel Biljana Gigic Sheetal Hardikar Doratha A. Byrd Adetunji T. Toriola Jennifer Ose Christopher I. Li David Shibata Cornelia M. Ulrich Balaji K. Tamarappoo Katelyn M. Atkins Jane C. Figueiredo |
| author_facet | Julia A. Levy Elham Kazemian Cody Ramin Nicole C. Loroña Maimoona Nadri Jordan O. Gasho Katrina D. Silos Andriana P. Nikolova Damini Dey Erin M. Siegel Biljana Gigic Sheetal Hardikar Doratha A. Byrd Adetunji T. Toriola Jennifer Ose Christopher I. Li David Shibata Cornelia M. Ulrich Balaji K. Tamarappoo Katelyn M. Atkins Jane C. Figueiredo |
| author_sort | Julia A. Levy |
| collection | DOAJ |
| description | ABSTRACT Background Prior studies have documented that patients with colorectal cancer (CRC) are at an increased risk of cardiovascular disease (CVD). Objectives To examine coronary artery calcium (CAC) as a marker of subclinical atherosclerosis and its association with major adverse cardiovascular events (MACE) in patients with CRC across the cancer treatment trajectory. Methods Adults with newly diagnosed CRC were enrolled in the prospective ColoCare study from 2017 to 2024. CAC was measured from routine diagnostic computed tomography (CT) and positron emission tomography‐CT scans at CRC diagnosis until 5 years post‐diagnosis. Atherosclerosis was defined as the presence of CAC. We used multivariable‐adjusted Fine and Gray models to assess the association between CAC and MACE risk, accounting for competing risks. Results Among 300 CRC patients, the most common CVD risk factors at cancer diagnosis were hypertension (37%), hyperlipidemia (24%), and diabetes (14%). During follow‐up (median = 5.3 years), 75 (25%) individuals experienced MACE: stroke (3%), new/worsening HF (9%), HF exacerbation requiring hospitalization (2%), coronary revascularization (3%), and death (19%). Among individuals with imaging at baseline (n = 101), 37 (36.6%) had CAC, and statins were not prescribed in 11 (55.0%) patients with moderate/high CAC. For those with serial imaging (n = 61), 31.1% showed worsening CAC and 3% developed new CAC. Baseline CAC conferred a higher risk of MACE (HR = 4.79; 95% CI: 1.05–21.75, p = 0.04) after accounting for cancer‐related deaths as a competing risk. Conclusions Subclinical atherosclerosis and MACE are common among patients with CRC. Integrating CAC from routine cancer imaging can identify patients who may benefit from cardio‐preventive treatment. |
| format | Article |
| id | doaj-art-9671b7070dc14be38814f2d2803e63fb |
| institution | OA Journals |
| issn | 2045-7634 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Cancer Medicine |
| spelling | doaj-art-9671b7070dc14be38814f2d2803e63fb2025-08-20T02:38:09ZengWileyCancer Medicine2045-76342025-05-011410n/an/a10.1002/cam4.70938Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal CancerJulia A. Levy0Elham Kazemian1Cody Ramin2Nicole C. Loroña3Maimoona Nadri4Jordan O. Gasho5Katrina D. Silos6Andriana P. Nikolova7Damini Dey8Erin M. Siegel9Biljana Gigic10Sheetal Hardikar11Doratha A. Byrd12Adetunji T. Toriola13Jennifer Ose14Christopher I. Li15David Shibata16Cornelia M. Ulrich17Balaji K. Tamarappoo18Katelyn M. Atkins19Jane C. Figueiredo20Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Computational Biomedicine Cedars‐Sinai Medical Center Los Angeles California USADepartment of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Cardiology Cedars‐Sinai Medical Center Los Angeles California USADepartment of Biomedical Sciences Cedars‐Sinai Medical Center Los Angeles California USADepartment of Cancer Epidemiology Moffitt Cancer Center Tampa Florida USADepartment of General, Visceral and Transplantation Surgery Heidelberg University Hospital Heidelberg GermanyDepartment of Population Health Sciences University of Utah Salt Lake City Utah USADepartment of Cancer Epidemiology Moffitt Cancer Center Tampa Florida USADivision of Public Health Sciences, Department of Surgery Washington University School of Medicine St. Louis Missouri USADepartment of Population Health Sciences University of Utah Salt Lake City Utah USADivision of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle Washington USADepartment of Surgery University of Tennessee Health Science Center Memphis Tennessee USADepartment of Population Health Sciences University of Utah Salt Lake City Utah USADepartment of Cardiovascular Medicine Mayo Clinic Scottsdale Arizona USADepartment of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USADepartment of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles California USAABSTRACT Background Prior studies have documented that patients with colorectal cancer (CRC) are at an increased risk of cardiovascular disease (CVD). Objectives To examine coronary artery calcium (CAC) as a marker of subclinical atherosclerosis and its association with major adverse cardiovascular events (MACE) in patients with CRC across the cancer treatment trajectory. Methods Adults with newly diagnosed CRC were enrolled in the prospective ColoCare study from 2017 to 2024. CAC was measured from routine diagnostic computed tomography (CT) and positron emission tomography‐CT scans at CRC diagnosis until 5 years post‐diagnosis. Atherosclerosis was defined as the presence of CAC. We used multivariable‐adjusted Fine and Gray models to assess the association between CAC and MACE risk, accounting for competing risks. Results Among 300 CRC patients, the most common CVD risk factors at cancer diagnosis were hypertension (37%), hyperlipidemia (24%), and diabetes (14%). During follow‐up (median = 5.3 years), 75 (25%) individuals experienced MACE: stroke (3%), new/worsening HF (9%), HF exacerbation requiring hospitalization (2%), coronary revascularization (3%), and death (19%). Among individuals with imaging at baseline (n = 101), 37 (36.6%) had CAC, and statins were not prescribed in 11 (55.0%) patients with moderate/high CAC. For those with serial imaging (n = 61), 31.1% showed worsening CAC and 3% developed new CAC. Baseline CAC conferred a higher risk of MACE (HR = 4.79; 95% CI: 1.05–21.75, p = 0.04) after accounting for cancer‐related deaths as a competing risk. Conclusions Subclinical atherosclerosis and MACE are common among patients with CRC. Integrating CAC from routine cancer imaging can identify patients who may benefit from cardio‐preventive treatment.https://doi.org/10.1002/cam4.70938atherosclerosiscolorectal cancercoronary artery calcium |
| spellingShingle | Julia A. Levy Elham Kazemian Cody Ramin Nicole C. Loroña Maimoona Nadri Jordan O. Gasho Katrina D. Silos Andriana P. Nikolova Damini Dey Erin M. Siegel Biljana Gigic Sheetal Hardikar Doratha A. Byrd Adetunji T. Toriola Jennifer Ose Christopher I. Li David Shibata Cornelia M. Ulrich Balaji K. Tamarappoo Katelyn M. Atkins Jane C. Figueiredo Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer Cancer Medicine atherosclerosis colorectal cancer coronary artery calcium |
| title | Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer |
| title_full | Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer |
| title_fullStr | Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer |
| title_full_unstemmed | Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer |
| title_short | Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer |
| title_sort | subclinical atherosclerosis and cardiovascular events among patients with colorectal cancer |
| topic | atherosclerosis colorectal cancer coronary artery calcium |
| url | https://doi.org/10.1002/cam4.70938 |
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