Microvascular Endothelial Dysfunction Predicts Cancer Later in Life

An early indicator of cardiovascular disease may also be used by clinicians to identify patients at a greater risk of developing cancer in the future.

A new study from investigators at the Mayo Clinic has found patients with microvascular endothelial dysfunction were at a two-fold greater risk of developing solid-tumor cancer later in life.

"The study demonstrated that noninvasive vascular function assessment may predict the future development of cancer," said lead investigator Amir Lerman, MD, director of cardiovascular research at Mayo Clinic. "More studies are needed, but assessment of vascular function potentially may predict individuals at risk."

In order to further evaluate the predictive value of microvascular endothelial dysfunction outside of cardiovascular disease, investigators designed a retrospective observational cohort study including patients who visited the Mayo Clinic between January 2006 and February 2014. All patients included in the study underwent endothelial function testing using the EndoPAT 2000 device at the clinical discretion of their evaluating physician.

Dysfunction was defined as a tonometry index of 2 or less. Median follow-up for patients in the study was 6 years.

Investigators identified a cohort of 687 patients during the study period. From this group, 194 were excluded due to follow-up periods lasting less than 90 days and 5 developed hematological malignancies—488 patients were included in the final analysis.

Upon analyses, 221 patients had a tonometry index of 2 or less and 267 were at an index greater than 2. Of the patients with dysfunction, 21 (9.5%) were diagnosed with incident solid-tumor cancer during the follow-up period. In comparison, 10 (3.7%) with a tonometry index greater than 2 were diagnosed with solid-tumor cancer (P=0.009). Among patients with dysfunction, the solid-tumor cancer-free survival rate was lower than those without dysfunction(log-rank P=0.017) (median follow-up 6.0 (3.0—9.1) years).

Investigators noted Cox proportional hazard analysis revealed the incidence of solid-tumor cancer with a hazard ratio of 2.52 (95% CI, 1.7-5.45, P=0.019) after adjusting for factors including age, sex, and coronary artery disease. Additionally, analyses indicated a hazard ratio of 2.83 (95% CI, 1.30-6.17, P=0.009) when adjusting for diabetes mellitus, hypertension, smoking status, and body mass index, 2.79 (95% CI, 1.21-6.41, P=0.016) when adjusting for fasting plasma glucose, systolic blood pressure, smoking status, and BMI, and 2.43 (95% CI, 1.10—5.34; P=0.028) after adjusting for Framingham risk score.

"This abnormal vasoreactivity should alert clinicians not only to the risk of cardiovascular disease but to malignancy, as well," Lerman added. "This risk prediction appears to precede the development of disease by more than five years."

This study, titled “Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer,” was published online in the European Journal of Preventive Cardiology.