Emily Lau, MD: Cancer Risk in Cardiology

The prevalence of cardiovascular disease among patients with cancer—and vice versa—has led to greater research into the associations between 2 of the most prevalent and burdensome disease groups in the world. It has also driven greater collaboration between cardiology and oncology, and fostered the growing role of the cardio-oncologist on treatment teams.

In an interview with MD Magazine® while at the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia, Emily Lau, MD, a cardiology fellow at Massachusetts General Hospital, detailed her team’s most recent research into the associations between cardiovascular risk factors and cancer prevalence.

Lau also discussed the burdens of a cardiovascular disease-cancer patient, and what the collaborative network of care currently looks like for such a patient.

MD Mag: What is the prevalence of cancer among patients with cardiovascular disease?

Lau: So, I think for a long time now we have, as a community, recognized that there is a link between heart disease and cancer—2 of the most common causes of both mortality and morbidity in the United States, if not worldwide. And what we were realizing is our research group actually does a lot of work looking at risk factors related to heart disease—specifically heart failure. And we found, interestingly, that many of these patients were dying of non-cardiovascular related causes, and when we probed further, we found that actually they were dying of cancer causes.

And so that was the initial spark, and the initial reason that we undertook this study. And essentially, we studied a large number of patients in the Framingham Heart Study, and we looked to identify the association of cardiovascular risk factors, cardiovascular risk scores, cardiac biomarkers, and then interim cardiovascular events, with cancer.

I think probably the 3 most important findings we found were that there were specific risk factors that we've known to be related to heart disease that were in fact predictive of cancer; we also found that a specific cardiac biomarker called BNP which is related to heart failure was also associated with increased risk of cancer; and finally—probably the most interesting thing we discovered was that if you were to develop some sort of heart event, whether that was an MI or heart failure, whatever the case may be, that actually increase your odds of developing cancer by something like seven-fold. So, pretty significant.

MD Mag: What is the burden of treating a patient with both cardiovascular disease and cancer?

Lau: You know, we spend a lot of time as cardiologists and as primary care physicians thinking about risk factors for heart disease. We've known for a long time that things like hypertension, diabetes, smoking all definitely increase your risk of heart disease. And we actually use a risk score called the ten-year ASCVD risk score to help us categorize which patients are very high-risk for developing heart disease in the next 10 years, and who are maybe at lower risk.

What we discovered is that folks who have a greater than 20% risk of developing some sort of heart event based on their risk factor profile were actually at a three-fold increased risk of developing cancer.

So, I think what's important now is that we've spent a lot of time thinking about trying to manage risk factors, so that we could prevent future heart disease. But I think we now need to be thinking about these same patients and their cancer risk, as well.

MD Mag: What is the network of care between cardiologists, oncologists, and cardio-oncologists?

Lau: I think cardio-oncology is a huge, booming field. I think, even at this meeting alone, there's so much discussion about the intersection between these 2 fields. At, present we study a lot about the cardiovascular effects of individuals who've been treated for cancers—so, what are the downstream effects of receiving chemotherapy or radiation treatments, for instance. What are their cardiac effects?

We're sort of flipping the question on its head, and sort of saying, ‘Well, what if you have heart disease? What is your future risk of cancer?’

And we're only starting to begin to better understand that there is a link in that direction. And I think that we need to do a whole lot more work to really understand, is this link between heart disease and cancer because we share risk factors, or is it that developing heart disease actually increases your risk of developing cancer for whatever reason?