BACKGROUND
Patients with coronary artery disease (CAD) are at risk of developing malignancies, given that cancer shares some risk factors with this disorder, as age, smoking, and even some dietary patterns1-3. Then, finding biomarkers that predict both the risk of cancer and of cardiovascular events could be useful in CAD patients.
Natriuretic peptides are secreted by cancer cells4, 5and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels are increased in patients with cancer6. Previously, we have reported that NT-proBNP plasma levels predict a future diagnosis of cancer in 704 patients with CAD from the Biomarkers in Acute Coronary Syndrome & Biomarkers in Acute Myocardial Infarction (BACS & BAMI) studies7. We launched the hypothesis that NT-proBNP could be merely detecting subclinical cancers rather than being a real predictor. Now we try to support this hypothesis by analyzing if this biomarker predicts a new cancer diagnosis only in the short-term but not in the long-run. For that purpose we have expanded the sample size and the follow-up of the same population, studying 962 patients with CAD free of malignancies at baseline, who developed 59 cancers at follow-up. We divided them into those receiving a cancer diagnosis in the first three years and those receiving this diagnosis beyond this time. Along with NT-proBNP, we also tested these biomarkers: monocyte chemoattractant protein-1 (MCP-1), involved in inflammation and atherothrombosis, among other processes8, 9; galectin-3, related to malignancies, heart failure, thrombosis, and renal dysfunction10, 11; high-sensitivity cardiac troponin I (hsTnI), which has been described to have prognostic value in stable CAD12; and vitamin D (calcidiol) plasma levels, as low levels of this molecule have been related to cancer13. High-sensitivity C-reactive protein (hsCRP) was studied as a reference given the large amount of information published on this biomarker on cardiovascular disease.