The relation between systemic inflammation and incident cancer in patients with stable cardiovascular disease: a cohort study.
AIMS
Low-grade inflammation, measured by elevated plasma concentrations of high-sensitive C-reactive protein (CRP), is a risk factor for cardiovascular disease (CVD). There is evidence that low-grade inflammation is also related to a higher risk of cancer. The present prospective cohort study evaluates the relation between low-grade systemic inflammation and risk of cancer in patients with stable CVD.


METHODS AND RESULTS
In total, 7178 patients with stable CVD and plasma CRP levels ≤10 mg/L were included. Data were linked to the Dutch national cancer registry. Cox regression models were fitted to study the relation between CRP and incident CVD and cancer. After a median follow-up time of 8.3 years (interquartile range 4.6-12.3) 1072 incident cancer diagnoses were observed. C-reactive protein concentration was related to total cancer [hazard ratio (HR) 1.35; 95% confidence interval (CI) 1.10-1.65] comparing last quintile to first quintile of CRP. Especially lung cancer, independent of histopathological subtype, was related to CRP (HR 3.39; 95% CI 2.02-5.69 comparing last to first quintile of CRP). Incidence of epithelial neoplasms and especially squamous cell neoplasms were related to CRP concentration, irrespective of anatomical location. Sensitivity analyses after excluding patients with a cancer diagnosis within 1, 2, and 5 years of follow-up showed similar results. No effect modification was observed by smoking status or time since smoking cessation (P-values for interaction > 0.05).


CONCLUSION
Chronic systemic low-grade inflammation, measured by CRP levels ≤10 mg/L, is a risk factor for incident cancer, markedly lung cancer, in patients with stable CVD. The relation between inflammation and incident cancer is seen in former and current smokers and is uncertain in never smokers.
["Van't Klooster|Cilie C|CC|", 'Ridker|Paul M|PM|', 'Hjortnaes|Jesper|J|', 'van der Graaf|Yolanda|Y|', 'Asselbergs|Folkert W|FW|', 'Westerink|Jan|J|', 'Aerts|Joachim G J V|JGJV|', 'Visseren|Frank L J|FLJ|']
D000368:Aged D002097:C-Reactive Protein D002318:Cardiovascular Diseases D016022:Case-Control Studies D006801:Humans D015994:Incidence D007249:Inflammation D008175:Lung Neoplasms D008875:Middle Aged D009369:Neoplasms D009375:Neoplasms, Glandular and Epithelial D018307:Neoplasms, Squamous Cell D009426:Netherlands D016016:Proportional Hazards Models D011446:Prospective Studies D012307:Risk Factors D012907:Smoking
Incident cancer High-sensitive C-reactive protein Risk factor Chronic systemic low-grade inflammation Patients with vascular disease