Red heart in the hand of a physician

A Mayo
-led study
involving 488 cardiac patients whose cases were followed for up to 12 years
finds that microvascular endothelial
, a
common early sign of cardiovascular disease, is associated with a greater than
twofold risk of cancer.

The study, published in the European Journal of Preventive Cardiology, finds that microvascular endothelial dysfunction may be a useful marker for predicting risk of solid-tumor cancer, in addition to its known ability to predict more advanced cardiovascular disease, says Amir Lerman, M.D., a Mayo Clinic cardiologist and the study’s senior author.

“The study
demonstrated that noninvasive vascular function assessment may predict the
future development of cancer,” says Dr. Lerman, who is director of cardiovascular
research at Mayo Clinic. “More studies are needed, but assessment of
vascular function potentially may predict individuals at risk.”

Microvascular endothelial
damage to the walls of small arteries in the heart, which affects their ability
to expand and limits the flow of oxygen-rich blood. Hypertension, high cholesterol,
obesity and diabetes are among the causes, and symptoms of dysfunction include
chest pain. The condition is treatable but difficult to detect.

The study reviewed
the cases of 488 patients who underwent microvascular endothelial function
assessment at Mayo Clinic between 2006 and 2014. The noninvasive procedure,
called reactive hyperemia peripheral
arterial tonometry
measures blood flow to the fingers during blood pressure inflation and release.

Dysfunction was
defined as a tonometry index at or below 2, and the median follow-up period was
six years. Of 221 patients identified as having dysfunction, 9.5% were
diagnosed with solid-tumor cancer during the follow-up period. This compared
with 3.7% of patients who had a tonometry index above 2. The findings were
consistent after adjusting for age, gender, coronary artery disease and other

The association
between microvascular endothelial dysfunction and cancer was independent but
more prominent among men and in patients with factors such as hypertension,
significant coronary artery disease, smoking and obesity.

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

Patients with
microvascular endothelial dysfunction tend to have other health issues, as well,
and that may have drawn more medical attention to these patients, resulting in
higher levels of incidental detection of cancer, according to the study. Whether
improvement in dysfunction translates into a reduced risk of cardiovascular disease
and cancer remains to be determined.

the mechanism underlying the association between microvascular endothelial
dysfunction and cancer needs to be defined in future studies,” Dr. Lerman


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