Prior Diagnosis of an Abdominal Aortic Aneurysm Is Associated with an Elevated Risk of Subsequent Cancer Diagnosis

Introduction: Epidemiological and mechanistic evidence suggests a potential causal link between cardiovascular disease (CVD) and cancer. Abdominal aortic aneurysms (AAA), a prevalent form of CVD with distinct genetic and biological etiologies, lack clarity regarding cancer risk compared to other CVD types. We conducted a retrospective cohort study using the IBM MarketScan Research Database to investigate whether AAA individuals face an increased cancer risk independent of traditional shared risk factors.

Methods: Enrolling individuals aged ≥18 with ≥36 months of continuous coverage between 2008 and 2020, we excluded those with potential Mendelian AAA etiologies, aortic aneurysms with nonspecific anatomic location, or pre-follow-up cancer diagnoses. A subgroup analysis was performed including individuals with Health Risk Assessment records that included smoking status and BMI. We compared three groups: 1) AAA, 2) non-AAA CVD, and 3) no-CVD.

Results: The propensity score-matched cohort comprised 58,993 AAA, 117,986 non-AAA CVD, and 58,993 no-CVD individuals. The 5-year cumulative incidence of any cancer was 13.1% (12.8 – 13.5%) in AAA, 10.1% (9.9 - 10.3%) in non-AAA CVD, and 9.6% (9.3 – 9.9%) in no CVD. Time-dependent multivariable-adjusted Cox proportional hazards regression models revealed AAA patients had a higher cancer risk than non-AAA CVD (HR: 1.28; 95% CI: 1.23-1.32; p-value: <0.001) or no-CVD (HR: 1.32; 95% CI: 1.26-1.38; p-value: <0.001). Results remained consistent after excluding common smoking-related cancers and when adjusting for tobacco use and BMI.

Conclusion: AAA patients may have a unique risk of cancer requiring further mechanistic study and investigation of the role of enhanced cancer screening.