Cardiac MRI Metrics of Subclinical Remodeling and Incident Cancer Risk in the MESA Cohort

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Summary of  Journal of the American Heart Association, https://doi.org/10.1161/JAHA.125.050573 
Dr. Xinjiang Cai  et al.

Points

Investigators evaluated long-term data from more than 6,000 asymptomatic adults across a multi-ethnic cohort to examine associations between subclinical cardiac remodeling and future cancer development.
Baseline cardiac MRI examinations were performed at enrollment and participants were monitored over an average follow-up period of 18 years to track all-site cancer incidence.
During the follow-up window researchers documented 790 new incident cancer cases including high-volume malignancies such as breast, colorectal, prostate, and lung cancers.
Worsening structural metrics revealed that an elevated left ventricular mass index correlated with a significantly increased risk of developing breast cancer later in life.
Functional measurements demonstrated that reduced peak left atrial strain was highly predictive of colorectal cancer whereas optimal atrial strain tracked with a lower disease incidence.

Summary

Clinically apparent cardiovascular disease exhibit an increased risk of malignancy, the relationship between early, asymptomatic structural heart alterations and oncogenesis remains unclear. To address this knowledge gap, investigators analyzed long-term data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort designed to track chronic disease development. The research sought to determine if baseline variations in myocardial mass and chamber function could serve as early indicators of elevated cancer susceptibility before the clinical onset of either disease entity.

The study architecture tracked a multi-ethnic cohort of more than 6,000 adults, aged 45 to 84 years, who presented with no known cardiovascular disease at the time of enrollment between 2000 and 2002. Baseline cardiac structure and function were rigorously quantified using advanced cardiac MRI. Over an average follow-up period spanning 18 years, multivariable statistical models were utilized to correlate baseline imaging metrics with the incidence of all major malignancies, including prostate, breast, colorectal, and lung cancers. During this extensive monitoring window, 790 new incident cancer cases were identified across the study population.

The analysis revealed distinct structural and functional correlations, demonstrating that cancer incidence increased as subclinical cardiac remodeling metrics worsened. The strongest statistical association emerged between elevated left ventricular mass index and an increased risk of future breast cancer, persisting after adjusting for traditional cardiovascular and oncological risk factors. Furthermore, depressed peak left atrial strain—a key operational metric of atrial contractility—was strongly predictive of an increased risk of colorectal cancer, whereas robust left atrial strain values correlated with a substantial reduction in colorectal cancer incidence. While these observational findings demonstrate significant associations rather than direct causation, they suggest that shared biological pathways connect early cardiac remodeling and oncogenesis.

Link to the article: https://www.ahajournals.org/doi/full/10.1161/JAHA.125.050573

References

Cai, X., White, Q., Juarez, J., Chehab, O., Ambale‐Venkatesh, B., Johnson, W. C., Hansen, S. L., Inoue, K., Lima, J. A. C., Watson, K. E., & McClelland, R. L. (2026). Association of subclinical cardiac remodeling with incident cancer in the mesa cohort. Journal of the American Heart Association, 15(12), e050573. https://doi.org/10.1161/JAHA.125.050573