Subclinical cardiac remodeling, assessed by advanced cardiac imaging, may help stratify individuals with subclinical CVD for future risk of incident cancer.A study using data from the MESA* cohort shows an association between subclinical cardiac remodeling and increased risk of cancer.
“Our study offers several insights into the complex bidirectional relationship between subclinical cardiovascular disease (CVD) and cancer,” the investigators said. “[O]ur results provide direct human evidence that subclinical cardiac remodeling, assessed by advanced cardiac imaging in asymptomatic individuals without overt CVD, is associated with increased risk of incident cancer.”
The overall cancer incidence was higher among participants with greater LVMI** and LVM/volume ratio; reduced LAVI***, LAEF***, PALS***, and LVEF** <50 percent; and LV hypertrophy. For LVMI, the stratified incidence rate (SIR) increased from 67.62 in stratum 1 of cardiac MRI measures to 108.6 in stratum 4. Conversely, measures of LA function (eg, LAEF, LAVI, PALS) showed lower SIRs in stratum 3, with the SIR for PALS dropping from 106.94 to 67.54.
Regarding why incident cancer was associated with LVMI and PALS rather than conventional functional metrics (ie, LVEF, LAEF), the researchers indicated that these two parameters “may reflect earlier stages of cardiac remodeling preceding overt dysfunction, which may render them more sensitive early indicators of systemic processes linked to cancer risk.”
Also, participants with significant LV or LA dysfunction were relatively few, as were the cancer events. This may have reduced the statistical power to detect associations between LVEF, LAEF, and cancer. [J Am Heart Assoc 2026;15:e050573]
Breast cancer, CRC
A significant association was observed between elevated LVMI and the hazard of breast cancer in the adjusted Cox proportional hazards model with a more conservative significance threshold of 0.01 (model 2##: hazard ratio [HR], 1.88; p=0.007). “This finding is independent of traditional CV risk factors, likely through cardiac secreted factors, such as periostin, and other unidentified mechanisms,” the researchers noted.
There was also a significant correlation between reduced PALS and the hazard of colorectal cancer (CRC; model 1#: HR, 0.52; p=0.005). “PALS may serve as an early marker for subclinical cardiac remodeling to identify individuals at higher risk for incident cancer,” they said.
Despite evidence supporting an association between PALS and breast and lung cancer in models 1 and 2, neither achieved the significance threshold (p<0.05).
Interdisciplinary preventive approach
The analysis included 6,214 MESA participants who were free of CVD and self-reported cancer at baseline. Over a median follow-up of 18.7 years, 790 patients (median age 66 years, 52.7 percent men) had incident cancer. Among participants with at least one cardiac MRI-derived measure of interest (n=4,596), 563 cancer events were reported. The median time to cancer detection was 8.45 years.
The findings suggest that, in the absence of symptoms or significant LVEF reduction, subclinical cardiac remodeling may identify a higher-risk phenotype associated with increased cancer risk, signifying the shared pathophysiological pathways between CVD and cancer, the researchers said. “These support a more integrated approach to risk stratification that incorporates imaging-based markers alongside traditional risk factors.”
The findings also underscore the importance of managing lifestyle factors and comorbidities and reducing systemic inflammation, they added. “Collectively, these integrated prevention strategies may mitigate the risk for both CVD and cancer at an early stage.”
“[Overall,] our findings suggest that subclinical cardiac remodeling assessed by advanced cardiac imaging may help stratify individuals with subclinical CVD for future incident cancer risk and integrate an interdisciplinary preventive approach toward risk prediction and prevention strategies for both preventive cardiology and oncology,” the researchers said.