{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:50:36Z","timestamp":1785333036169,"version":"3.55.0"},"reference-count":61,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prior studies have documented that patients with colorectal cancer (CRC) are at an increased risk of cardiovascular disease (CVD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine coronary artery calcium (CAC) as a marker of subclinical atherosclerosis and its association with major adverse cardiovascular events (MACE) in patients with CRC across the cancer treatment trajectory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults with newly diagnosed CRC were enrolled in the prospective ColoCare study from 2017 to 2024. CAC was measured from routine diagnostic computed tomography (CT) and positron emission tomography\u2010CT scans at CRC diagnosis until 5\u2009years post\u2010diagnosis. Atherosclerosis was defined as the presence of CAC. We used multivariable\u2010adjusted Fine and Gray models to assess the association between CAC and MACE risk, accounting for competing risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 300 CRC patients, the most common CVD risk factors at cancer diagnosis were hypertension (37%), hyperlipidemia (24%), and diabetes (14%). During follow\u2010up (median\u2009=\u20095.3\u2009years), 75 (25%) individuals experienced MACE: stroke (3%), new\/worsening HF (9%), HF exacerbation requiring hospitalization (2%), coronary revascularization (3%), and death (19%). Among individuals with imaging at baseline (<jats:italic>n<\/jats:italic>\u2009=\u2009101), 37 (36.6%) had CAC, and statins were not prescribed in 11 (55.0%) patients with moderate\/high CAC. For those with serial imaging (<jats:italic>n<\/jats:italic>\u2009=\u200961), 31.1% showed worsening CAC and 3% developed new CAC. Baseline CAC conferred a higher risk of MACE (HR\u2009=\u20094.79; 95% CI: 1.05\u201321.75, <jats:italic>p<\/jats:italic>\u2009=\u20090.04) after accounting for cancer\u2010related deaths as a competing risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Subclinical atherosclerosis and MACE are common among patients with CRC. Integrating CAC from routine cancer imaging can identify patients who may benefit from cardio\u2010preventive treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70938","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T10:53:14Z","timestamp":1747219994000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Subclinical Atherosclerosis and Cardiovascular Events Among Patients With Colorectal Cancer"],"prefix":"10.1002","volume":"14","author":[{"given":"Julia A.","family":"Levy","sequence":"first","affiliation":[{"name":"Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"},{"name":"Department of Internal Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Kazemian","sequence":"additional","affiliation":[{"name":"Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cody","family":"Ramin","sequence":"additional","affiliation":[{"name":"Department of Computational Biomedicine Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8302-3157","authenticated-orcid":false,"given":"Nicole C.","family":"Loro\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maimoona","family":"Nadri","sequence":"additional","affiliation":[{"name":"Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-3161","authenticated-orcid":false,"given":"Jordan O.","family":"Gasho","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina D.","family":"Silos","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andriana P.","family":"Nikolova","sequence":"additional","affiliation":[{"name":"Department of Cardiology Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damini","family":"Dey","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology Moffitt Cancer Center  Tampa Florida USA"},{"name":"Epidemiology and Genomics Program, Division of Cancer Control &amp; Population Sciences National Cancer Institute  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biljana","family":"Gigic","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0292-6168","authenticated-orcid":false,"given":"Sheetal","family":"Hardikar","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doratha A.","family":"Byrd","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology Moffitt Cancer Center  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1079-2606","authenticated-orcid":false,"given":"Adetunji T.","family":"Toriola","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Department of Surgery Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Ose","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah  Salt Lake City Utah USA"},{"name":"University of Applied Sciences and Arts Department of Information and Communication  Hanover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-0743","authenticated-orcid":false,"given":"Christopher I.","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Tennessee Health Science Center  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7641-059X","authenticated-orcid":false,"given":"Cornelia M.","family":"Ulrich","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balaji K.","family":"Tamarappoo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn M.","family":"Atkins","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8040-3341","authenticated-orcid":false,"given":"Jane C.","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Medicine Samuel Oschin Comprehensive Cancer Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"},{"name":"Department of Computational Biomedicine Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21731"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.9739"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2018.7078"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-018-01382-x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.421"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2014.05.010"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2555-8"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.7_suppl.113"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2010.10.002"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.04.042"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.5469"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020406"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-013-0267-9"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21440"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.24343"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17018-9"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2020.12.003"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/030089168206800609"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.11.1795"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.7042"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-017-0835-0"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(99)00221-X"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4913"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27871"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-022-04129-3"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy217"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2017.02.010"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2018.02.001"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000752"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2019.08.005"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2021.10.007"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015306"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-020-02111-0"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.02.005"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0695"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0676"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-18-0773"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90282-T"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2018.2804799"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01440-5"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.329"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_10_45_1","volume-title":"RStudio: Integrated Developed for R","author":"Team P","year":"2023"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.1144"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab099"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.05.027"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000677"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.02.051"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-3011"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.23242"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.3747\/co.24.3684"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/394740"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.729713"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.04.008"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.647179"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.10.079"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.7440"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.09.003"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2022.11.011"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1488853"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.70938","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T10:32:44Z","timestamp":1748428364000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.70938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":61,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/cam4.70938"],"URL":"https:\/\/doi.org\/10.1002\/cam4.70938","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"assertion":[{"value":"2024-12-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70938"}}