Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 3, June 2025, pages 202-211


Progression of Atherosclerosis and Hypothesis on the Relationship Between Microvascular Dysfunction, Cardiovascular Risk, and Cancer

Figures

Figure 1.
Figure 1. TPA percentiles by age for men. TPA: total plaque area.
Figure 2.
Figure 2. TPA percentiles by age for women. TPA: total plaque area.
Figure 3.
Figure 3. Proportion of men and women with advanced atherosclerosis.

Tables

Table 1. Baseline Characteristics of All Subjects by Risk Groups
 
CharacteristicsMale, type I, IIa, IIb, IVaMale, type III, IVbP valueFemale, type I, IIa, IIb, IVaFemale type, III, IVbP value
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; CABG: coronary artery bypass grafting; CVD: cardiovascular disease; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; MACE: major adverse cardiovascular event; PROCAM: Prospective Cardiovascular Munster Study; PTCA: percutaneous transluminal coronary angioplasty; SBP: systolic blood pressure; TPA: total plaque area.
N2,0525401,761167
Age50 ± 754 ± 6< 0.000150 ± 755 ± 6< 0.0001
BMI, kg/m227.47 ± 4.0827.94 ± 4.200.00225.40 ± 4.6826.02 ± 4.720.101
Current smoker458 (22.3%)238 (43.5%)< 0.0001339 (19.3%)79 (47.3%)< 0.0001
LDL-cholesterol, mg/dL150 ± 33159 ± 40< 0.0001143 ± 33160 ± 400.002
HDL-cholesterol, mg/dL51 ± 1248 ± 110.00165 ± 1563 ± 140.116
Triglycerides, mg/dL170 ± 117188 ± 1230.001112 ± 58143 ± 710.005
SBP, mm Hg126 ± 15135 ± 19< 0.0001122 ± 16131 ± 190.0002
DBP, mm Hg82 ± 884 ± 10< 0.000178 ± 986 ± 120.143
Diabetes mellitus76 (3.7%)47 (8.6%)< 0.000125 (1.4%)11 (6.6%)0.009
Antihypertensive therapy440 (21.4%)206 (37.7%)< 0.0001318 (18.1%)80 (47.9%)< 0.0001
Positive family history450 (21.9%)159 (29.1%)0.034485 (27.5%)65 (38.9%)< 0.0001
PROCAM risk6.5±6.5%14.4±11.1%< 0.00011.5±2.4%5.1±5.4%< 0.0001
TPA, mm232 ± 33150 ± 64< 0.000116 ± 24123 ± 63< 0.0001
Max. plaque thickness, mm1.7 ± 0.52.9 ± 0.8< 0.00011.6 ± 0.43.1 ± 0.6< 0.0001
Event (MACE, CABG, PTCA, stenosis)60 (2.9%)128 (23.4%)< 0.00014 (0.2%)13 (7.8%)< 0.0001
Carcinoma21 (1.0%)34 (6.2%)< 0.000112 (0.7%)3 (1.8%)0.289
Follow-up, months (min. - max.)73 (3 - 156)74 (3 - 145)0.03274 (2 - 155)75 (2 - 139)0.836
Death of all causes14 (0.7%)42 (7.7%)< 0.00016 (0.3%)0< 0.0001
Death of CVD5 (0.2%)17 (3.1%)0.00042 (0.1%)0< 0.0001
Death of carcinoma4 (0.2%)20 (4.4%)< 0.00011 (0.06%)0< 0.0001

 

Table 2. Proportion of Men With Progression to High Plaque Risk
 
Men, type I, IIa, IIb, IVaProgression in type III, IVbP value (t-test)
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N1,913139
Age50 ± 650 ± 50.5042
BMI, kg/m227.47 ± 4.0827.80 ± 4.480.4030
Current smoker423 (22.1%)40 (28.8%)0.0954
LDL-cholesterol, mg/dL150 ± 33153 ± 320.2661
HDL-cholesterol, mg/dL51 ± 1152 ± 130.4186
Triglycerides, mg/dL169 ± 116174 ± 1330.6990
SBP, mm Hg127 ± 16130 ± 170.0047
DBP, mm Hg81 ± 883 ± 100.0763
Diabetes mellitus67 (3.5%)9 (6.5%)0.1662
Antihypertensive therapy409 (21.4%)34 (24.5%)0.4240
Positive family history423 (22.1%)27 (19.4%)0.4436
PROCAM risk6.5±6.4%8.1±7.5%0.0360
TPA, mm230 ± 3353 ± 30< 0.00001
Max. plaque thickness, mm1.7 ± 0.51.79 ± 0.50.000017

 

Table 3. Proportion of Women With Progression to High Plaque Risk
 
Women, type I, IIa, IIb, IVaProgression in type III, IVbP value (t-test)
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N1,72239
Age50 ± 651 ± 60.1942
BMI, kg/m225.41 ± 4.8024.03 ± 5.920.0186
Current smoker351 (20.4%)12 (30.8%)0.1767
LDL-cholesterol, mg/dL143 ± 32146 ± 350.6567
HDL-cholesterol, mg/dL65 ± 1565 ± 130.9377
Triglycerides, mg/dL112 ± 59118 ± 600.5433
SBP, mm Hg121 ± 16126 ± 180.1116
DBP, mm Hg78 ± 978 ± 90.9849
Diabetes mellitus27 (1.6%)0 (0%)< 0.0001
Antihypertensive therapy308 (17.9%)8 (20.5%)0.6998
Positive family history475 (27.6%)10 (25.6%)0.7876
PROCAM risk1.5±2.5%1.8±2.4%0.5312
TPA, mm217 ± 2448 ± 34< 0.0001
Max. plaque thickness, mm1.6 ± 0.42.1 ± 0.5< 0.0001

 

Table 4. Proportion of Men and Women With Progression to High Plaque Risk by Age Group
 
25 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 65
Type III, IVb, men0.3%0.8%2.2%4.5%9.5%12.5%22.2%26.8%
No. of men examined with follow-up477584499335147
No. of which change in type III/IVb, men244046262
Change with follow-up, men5.0%6.8%9.2%7.8%1.4%
Type III, IVb, women0.0%0.0%0.9%0.9%2.8%4.1%8.0%9.2%
No. of women examined with follow-up348486480324125
No. of which change in type III/IVb, women7515102
Change with follow-up, women2.0%1.0%3.1%3.1%1.6%

 

Table 5. Comparison of Risk Factors in Men With Cancer and Without Cancer, CVD
 
Men without cancer, CVDMen with cancerP value (t-test)
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; CVD: cardiovascular disease; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N2,39755
Age50 ± 655 ± 50.00003
BMI, kg/m227.48 ± 4.0827.18 ± 4.480.53300
Current smoker603 (25.2%)23 (41.8%)0.01738
LDL-cholesterol, mg/dL151 ± 33151 ± 320.94355
HDL-cholesterol, mg/dL50 ± 1152 ± 130.52725
Triglycerides, mg/dL172 ± 116198 ± 1330.26128
SBP, mm Hg128 ± 16135 ± 170.02165
DBP, mm Hg82 ± 884 ± 100.05588
Diabetes mellitus103 (4.3%)2 (3.6%)0.79888
Antihypertensive therapy572 (23.9%)19 (34.5%)0.10744
Positive family history549 (22.9%)13 (23.6%)0.90068
PROCAM risk7.5±6.4%12.8±7.5%0.03379
TPA, mm249 ± 33103 ± 30< 0.00001
Max. plaque thickness, mm2.1 ± 0.52.6 ± 0.50.00037

 

Table 6. Comparison of Risk Factors in Men With CVD and Without Cancer, CVD
 
Men without cancer, CVDMen with CVDP value (t-test)
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; CVD: cardiovascular disease; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N2,397188
Age50 ± 654 ± 6< 0.00001
BMI, kg/m227.48 ± 4.0828.10 ± 4.080.0161
Current smoker603 (25.2%)85 (45.2%)< 0.00001
LDL-cholesterol, mg/dL151 ± 33161 ± 330.00065
HDL-cholesterol, mg/dL50 ± 1148 ± 110.00275
Triglycerides, mg/dL172 ± 116194 ± 1160.01691
SBP, mm Hg128 ± 16133 ± 160.00153
DBP, mm Hg82 ± 883 ± 80.12071
Diabetes mellitus103 (4.3%)20 (10.6%)0.00620
Antihypertensive therapy572 (23.9%)68 (36.2%)0.00081
Positive family history549 (22.9%)58 (30.9%)0.02357
PROCAM risk7.5±6.4%14.9±6.4%< 0.00001
TPA, mm249 ± 33133 ± 33< 0.00001
Max. plaque thickness, mm2.1 ± 0.52.7 ± 0.5< 0.00001

 

Table 7. Comparison of Risk Factors in Men With CVD and With Cancer
 
Men with CVDMen with cancerP value (t-test)
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; CVD: cardiovascular disease; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N18855
Age54 ± 655 ± 50.9690
BMI, kg/m228.10 ± 4.0827.18 ± 4.480.0650
Current smoker85 (45.2%)23 (41.8%)0.6857
LDL-cholesterol, mg/dL161 ± 33151 ± 320.0677
HDL-cholesterol, mg/dL48 ± 1152 ± 130.0731
Triglycerides, mg/dL194 ± 116198 ± 1330.8708
SBP, mm Hg133 ± 16135 ± 170.4497
DBP, mm Hg83 ± 884 ± 100.4753
Diabetes mellitus20 (10.6%)2 (3.6%)0.0413
Antihypertensive therapy68 (36.2%)19 (34.5%)0.8620
Positive family history58 (30.9%)13 (23.6%)0.3092
PROCAM risk14.9±6.4%12.8±7.5%0.4608
TPA, mm2133 ± 33103 ± 300.0153
Max. plaque thickness, mm2.7 ± 0.52.6 ± 0.50.5322

 

Table 8. Baseline Characteristics for All Subjects With Low and Intermediate Risk With and Without Follow-Up
 
Male, type I, IIa, IIb, IVa follow-upMale without follow-upP valueFemale, type I, IIa, IIb, IVa follow-upFemale without follow-upP value
The mean values with the standard deviations or the percentages are shown. BMI: body mass index; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PROCAM: Prospective Cardiovascular Munster Study; SBP: systolic blood pressure; TPA: total plaque area.
N2,0521,4941,7611,684
Age50 ± 750 ± 80.12250 ± 750 ± 40.158
BMI, kg/m227.47 ± 4.0827.60 ± 4.080.37525.40 ± 4.6825.63 ± 4.980.174
Current smoker458 (22.3%)335 (22.4%)0.966339 (19.3%)337 (20.0%)0.778
LDL-cholesterol, mg/dL150 ± 33150 ± 400.719143 ± 33145 ± 350.361
HDL-cholesterol, mg/dL51 ± 1250 ± 200.07265 ± 1564 ± 120.487
Triglycerides, mg/dL170 ± 117171 ± 1220.896112 ± 58119 ± 640.123
SBP, mm Hg126 ± 15128 ± 160.181122 ± 16123 ± 190.095
DBP, mm Hg82 ± 882 ± 110.06678 ± 979 ± 100.067
Diabetes mellitus76 (3.7%)56 (3.7%)0.98525 (1.4%)33 (1.9%)0.205
Antihypertensive therapy440 (21.4%)363 (24.3%)0.058318 (18.1%)333 (19.8%)0.151
Positive family history450 (21.9%)307 (20.5%)0.305485 (27.5%)448 (26.6%)0.639
PROCAM risk6.5±6.5%6.5±9.46%0.6931.5±2.4%1.8±2.7%0.058
TPA, mm232 ± 3330 ± 260.06816 ± 2415 ± 270.052
Max. plaque thickness, mm1.7 ± 0.51.6 ± 0.40.7131.6 ± 0.41.6 ± 0.50.072