Cardiovascular disease (CVD) and cancer are two of the leading global causes of death and share several common risk factors, including aging, smoking, obesity, diabetes, and inactive lifestyles. As cancer detection and treatment improve, the number of survivors living with long-term health challenges, including heart disease, continues to rise. Conventionally, the assessment of cardiovascular risk in patients with cancer, especially during the period when they receive cancer therapy, which may be cardiotoxic, involves the use of cardiac biomarkers such as high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Yet, according to recent reports, these biomarkers may play a role in predicting cancer development, even in people without pre-existing heart disease.
To investigate this potential, scientists examined the data in the Multi-Ethnic Study of Atherosclerosis (MESA), a long-term community-based study of 6,814 U.S. adults aged 45-84 years who had no clinical cases of CVD and cancer at the baseline. The study included four racial and ethnic groups: non-Hispanic White, Black, Hispanic/Latino, and Chinese, recruited to participate in the study between 2000 and 2002. Researchers measured hs-cTnT and NT-proBNP levels in the blood samples taken at baseline. The occurrence of cancer was monitored through the clinical records and self-reported symptoms during a median follow-up of 17.8 years. Age, sex, race/ethnicity, lifestyle factors, and other relevant clinical variables are used to assess the relationship between the biomarker levels and cancer incidence.
Among the more than 6,000 participants, higher baseline measures of hs-cTnT and NT-proBNP were persistently accompanied by high chances of developing cancer. Participants reporting a concentration of hs-cTnT greater than 8.80 ng/L were at almost a 2.8-fold greater risk of cancer than participants with undetectable levels. Likewise, patients in the top quartile of NT-proBNP were at more than twofold increased risk of cancer in comparison to patients in the bottom quartile. These two biomarkers were strongly associated with colorectal cancer, but only NT-proBNP was associated with increased risk of lung cancer. Interestingly, when biomarker levels were compared to sex-related cancers (breast, ovarian, and prostate cancers), there was no consistent correlation between them.
These results confirm the growing appreciation for the biological connection between the processes that lead to cardiovascular disease and cancer. Previous literature already provided evidence that cancer survivors have a greater risk of developing CVD, possibly because of common mechanisms such as inflammation, oxidative stress, and tissue remodeling. Recently, findings of this study indicate that perhaps, it is also possible that minor indicators of heart dysfunction, which are manifested by higher hs-cTnT and NT-proBNP levels, are a sign that they are more likely to develop cancer even in non-known patients with heart disease.
The strengths of the study are the large size of the sample, its diversity, and its follow-up. However, there are limitations to consider, including that it uses only hospital-based cancer judgments, does not include cancer-staging information, and lacks physician adjudication of the cancer cases. Additionally, although the associations are significant, causation cannot be determined based solely on observations.
In this MESA study landmark, the hs-cTnT and NT-proBNP combination showed the promise not only as early predictors of cardiovascular issues but also as predictive of cancer. These results might result in a change in the approach to the use of cardiac biomarkers in preventive health care and open the possibility of more research on the usefulness of such biomarkers in long-term cancer monitoring, particularly of colorectal cancer and lung cancer.
References: Cai X, White Q, Johnson WC, et al. Baseline cardiac biomarker levels as predictors of cancer risk in the MESA cohort. JACC Adv. 2025;4(7):101884. doi:10.1016/j.jacadv.2025.101884
