Oncological diseases are frequently associated to cardiovascular pathologies. This is partially explained by shared risk factors, such as arterial hypertension and diabetes, cardiotoxic side-effects of oncological therapies and a potentially direct crosstalk between cancer and the heart.

To investigate the relationship between cancer and coronary artery disease, we retrospectively collected data from 40.328 patients who were subjected to cardiac catherization from 01/2006 to 12/2017 at our department. 6.044 of these patients (15%) were diagnosed with cancer, confirmed by the national cancer registry. Most of them were diagnosed with breast cancer (n= 657, 11 %), prostate cancer (n=664, 11 %) or lung tumours (n=1006, 17 %). Overall 11.779 patients underwent percutaneous coronary interventions (PCI). 

To compare cancer and non-cancer patients, we performed a 1:1 propensity score matching according to age, gender and the shared risk factors diabetes and arterial hypertension. Comparing these two groups, we observed a significant higher proportion of PCIs in patients without diagnosis of cancer (cancer, 1635 PCIs vs. non cancer, 1876 PCIs, p< 0.0001, Log-Rank Test) as well as PCI at an younger age. Subgroup analysis according to left ventricular (LV)-function and levels of the cardiac biomarkers hsTnT and NT-proBNP showed even more pronounced effects (EF <30%: cancer, 267 PCIs vs. non cancer, 357 PCIs, p< 0.0001, Log-Rank Test; hsTnT >14 pg/ml: cancer, 1139 PCIs vs. non cancer, 1260 PCIs, p<0.0001, Log-Rank Test). In contrast to the higher rate of PCIs in non-cancer patients, the level of cardiac biomarkers was significantly higher in cancer patients (mean hsTnT: cancer, 29 pg/ml vs. non-cancer 24 pg/ml, p = 0.0049; mean NT-proBNP cancer, 314 ng/l vs. non-cancer, 202 ng/l; p < 0.0001, Mann-Whitney Test) in patients with EF>50%. NT-proBNP, but not hsTnT, was higher in cancer patients on every level of reduced EF compared to non-cancer patients.

We observed more cancer patients with pathological increase in cardiac biomarkers than non-cancer patients, independent of classical risk factors for atherosclerosis. This effect is further independent of a significant coronary artery disease since non-cancer patients received significantly more coronary interventions. Increased cardiac biomarker call for a better cardiac assessment of patients with malignant disease and underline their status as high risk patients, independent of atherosclerosis and left ventricular ejection fraction.