Coronary Plaque Burden and Plaque Composition in Long-Term Cancer Survivors: A Comparative CCTA Study

Abstract

The increased risk of atherosclerotic cardiovascular disease in cancer survivors is not fully elucidated. Understanding the coronary plaque burden and composition in survivors could address this gap. To determine whether cancer survivorship is associated with greater coronary plaque burden and more adverse plaque than non-cancer controls. This analysis included asymptomatic cancer survivors ≥5 years after therapy and non-cancer controls from prospectively enrolled CT coronary angiography screening cohorts. Primary outcomes were total plaque burden and low-attenuation plaque (LAP) percent atheroma volume (PAV, defined as plaque volume over vessel volume). Linear regression was used to assess the association of survivorship with log-transformed plaque measures, adjusted for age, sex, blood pressure, diabetes, glomerular filtration rate, smoking, and body mass index. Among 1,725 screened participants, this study included 97 cancer survivors (63.9% breast cancer, 15.5% haematological malignancies) and 365 intermediate-risk controls with a coronary artery calcium (CAC) score of 1-400. Survivors were older (67.7±4.4 vs 58.3±6.9 years), more often female (77.3% vs 42.4%), and had more comorbidities (all p<0.050). Cancer survivorship was associated with 10% higher total plaque PAV (95% CI 1.02–1.18; p=0.011) and 45% higher LAP PAV (95% CI 1.11–1.91; p=0.007). The association persisted after propensity matching and further adjustment for lipids and CAC. Absolute LAP volume did not differ overall (1.47 vs 1.86 mm3; p=0.41), but survivors had markedly smaller vessels (125 vs 224 mm3; p<0.001). After adjustment for vessel volume, LAP burden was higher in survivors whether expressed as PAV (1.56; p=0.002) or absolute volume (1.43; p<0.001) Within this selected, statin-naïve cohort with CAC scores of 1-400, cancer survivorship was associated with greater plaque burden relative to measured vessel volume, with the clearest association observed for LAP.