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Comprehensive analysis of clinico-pathological data reveals heterogeneous relations between atherosclerosis and cancer
  1. Jan Budczies1,
  2. Moritz von Winterfeld1,
  3. Frederick Klauschen1,
  4. Anna-Christin Kimmritz1,
  5. Jan-Marcus Daniel2,
  6. Arne Warth3,
  7. Volker Endris3,
  8. Carsten Denkert1,
  9. Heidi Pfeiffer4,
  10. Wilko Weichert3,
  11. Manfred Dietel1,
  12. Daniel Wittschieber4,
  13. Albrecht Stenzinger3
  1. 1Institute of Pathology, Charité University Hospital, Berlin, Germany
  2. 2Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
  3. 3Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
  4. 4Institute of Legal Medicine, University Hospital Münster, Münster, Germany
  1. Correspondence to Dr Albrecht Stenzinger, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg 69120, Germany; albrecht.stenzinger{at}


Aims Atherosclerosis and cancer share common risk factors and involve similar molecular pathomechanisms. Most clinical and epidemiological studies show a positive correlation between atherosclerosis and smoking-related cancers and heterogeneous results for non-smoking-related cancers. However, up-to-date large-scale autopsy studies including a detailed analysis of cancer types are lacking. Therefore, we sought to investigate the relation between major cancer types and the grade of atherosclerosis in a recent well-powered autopsy cohort.

Methods In 2101 patients, both autopsy data and clinical data including demographics, disease groups, tumour type, cause of death and grade of atherosclerosis were reviewed and statistically analysed.

Results We found cancer in general is associated with less atherosclerosis (OR 0.60, p<0.0001). In particular, haematological neoplasm and sarcomas were associated with much less atherosclerosis (OR=0.45, p<0.0001 and OR=0.43, p=0.087), while carcinomas were associated with moderately less atherosclerosis (OR=0.72, p=0.002). Furthermore, non-smoking-related cancers were associated with much less atherosclerosis (OR=0.41, p<0.0001), while possibly smoking-related cancer and smoking-related cancer showed no significant association. In a comprehensive analysis of 21 cancer types, biliary tract cancer, lymphomas/lymphoid leukaemias and kidney cancer were associated with much less atherosclerosis (OR=0.19, p<0.0001; OR=0.41, p<0.0001; and OR=0.48, p=0.029). In an exploratory analysis of treatment strategies, we found that tumours with a recommendation of oxazaphosphorines and pyrimidine antagonist treatment were significantly associated with less atherosclerosis (OR=0.33, p=0.0068 and OR=0.58, p=0.012).

Conclusions In conclusion, the study showed an inverse association between cancer and atherosclerosis postmortem that depends on the cancer type and suggests a possible impact of chemotherapy regimens.


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