Emily Lau, MD: Progressing Heart Disease-Cancer Risk Association Understanding

New study findings show cancer risk is nearly seven-fold in patients with a heart event such as myocardial infarction or heart failure. Though it adds to the developing understanding of an association between heart disease and cancer risks, it does not explain the entire mechanism of the association. More work is needed.

In an interview with MD Magazine® while at the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia this week, Emily Lau, MD, a cardiology fellow with Massachusetts General Hospital, looked into how inflammation-targeting therapies may benefit comorbid patients, and what more needs to be done to improve frontline diagnosis and care of patients with either disease state—and risk of the other.

MD Mag: What are some of the therapies which target inflammation associated with heart disease and cancer?

Lau: Just yesterday, there was a big study looking at colchicine, which is an anti-inflammatory therapy and its effects on cardiovascular events. And in fact, there was reduction in cardiovascular events—from a medicine that actually up until now we knew only targeted inflammation.

And just even 2 years ago, there was a therapy—canakinumab, which is a monoclonal antibody and it is an anti-inflammatory therapy. And what we found, or what the investigators found, was that the rates of cardiovascular disease were decreased. But then surprisingly, they also saw the rates of lung cancer were also decreased.

So I think that there is there's a lot of interest in better understanding how inflammation is related in heart disease, how inflammation is living in cancer, and is this a potential mechanism that links the 2 disease entities.

MD Mag: What do physicians need to do to assess for either heart disease or cancer risk when a physician presents with one of the two?

Lau: I think that we still don't know enough about this link between if somebody has developed heart disease and their future cancer risk to be able to necessarily change practice patterns quite yet. But I definitely think that the field is moving in that direction.

You know, our study says that you know if your ten-year ASCVD risk is high, you should potentially not only be having a discussion with your primary care physician, your cardiologist, your oncologist about your future of cardiovascular risk. But, do we need to be thinking about additional screening for cancer? Do we need to be more mindful about that?

That, I think, remains to be seen, as we start to better understand the mechanisms and the connections between these two disease processes. But I certainly think that that's exactly where the field is moving.

MD Mag: What’s the next step in further understanding the heart disease-cancer risk association?

Lau: So for our study specifically, we studied this in a very large group of patients from the Framingham Heart Study. But it is one group—it's a part of a community in Framingham, Massachusetts. And so we're hoping to validate these data in another group, in the Netherlands, a group that we collaborate very closely with.

And so, I think that will be very helpful to better understand if there's heterogeneity across different populations—is this something that we're actually seeing across the globe? And there's actually been a number of studies looking mechanistically—even animal studies trying to better understand, just as you say, the chicken or the egg. Is it that if you develop heart failure, that there's something that may increase your risk for developing cancer—whether it's inflammation, whether it's secreted factors? What is the cause? Is there truly cause and effect?

We don't know that yet. Our work is observational, so it really shows us association. But I think the real interesting question will be, does heart disease truly cause cancer and/or at least increase the risk of cancer? And is the arrow pointed in that direction?