Cancer incidence and overall survival in patients with abdominal aortic aneurysm compared to patients with coronary artery disease

Background: Recent studies have highlighted the importance of cancer screening in patients with cardiovascular diseases and the high incidence of malignancy in these patient populations. The aim of this study was to determine cancer incidence and overall survival (OS) in patients with abdominal aortic aneurysm (AAA) compared with patients with coronary artery disease (CAD). Methods: Patients with AAA (n = 151) and those with CAD (n = 539) who were admitted to the University Hospital of Liège (Belgium) between 2009 and 2011 were followed through December 2023. Diagnosis was confirmed by computed tomography scan for patients with AAA and by coronarography for patients with CAD. Patients with cancer or with a history of cancer, as well as patients with CAD affected by AAA, were excluded. Demographic variables and cardiovascular disease risk factors were collected at baseline. During follow-up, cases of cancer and deaths were recorded, along with surgeries. Study outcomes were the cumulative incidence rate of cancer and OS assessed by Cox and competing risk models. Results: At baseline, the AAA and CAD cohorts differed significantly for several demographic and clinical characteristics. At 15 years of follow-up, no differences in the cancer incidence rates were observed between patients with AAA and patients with CAD (30% vs 28%; P = .60). A higher risk of cancer was detected among patients with AAA as compared with patients with CAD at >7 years of follow-up (hazard ratio, 1.87; 95% confidence interval; 1.09-3.20; P = .023). Female sex and aspirin use were identified as protective factors for cancer, regardless of the group. Although cancer-free survival was comparable in the two groups (P = .097), OS differed between the AAA and CAD groups (hazard ratio, 1.54; 95% confidence interval; 1.22-1.94; P = .0002). In the adjusted mortality risk analysis, age, smoking status, diabetes, chronic obstructive pulmonary disease, renal insufficiency, peripheral artery disease, and C-reactive protein values of ≥6 mg/L were associated with poor survival. Conclusions: The long-term risk of cancer was higher in patients with AAA than in patients with CAD, and the OS was lower. In both groups, aspirin use and female sex were protective factors for cancer development, but not for mortality. Differences in cancer type distribution were also observed, suggesting distinct risk profiles that warrant close monitoring.