Cardiovascular Disease Risk Among Cancer Survivors

Abstract

Background: Over 80% of adult patients diagnosed with cancer survive long-term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies utilizing adjudicated cancer and CVD events are lacking. Objectives: Assess the risk of CVD in cancer survivors in a prospective community-based study. Methods: We included 12,414 ARIC participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these endpoints. We used multivariable Poisson and Cox regression to estimate the association of cancer with incident CVD. Results: Mean age was 54, 55% were female, and 25% Black. 3,250 (25%) participants had incident cancer over a median 13.6 years of follow-up. Age-adjusted IR of CVD (per 1,000 person-years) were 27.0 (24.7, 29.1) for cancer survivors and 12.0 (11.5, 12.4) for non-cancer controls. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR 1.37, 95% CI 1.26, 1.50), HF (HR 1.52, 95% CI 1.38, 1.68), and stroke (HR 1.22, 95% CI 1.03, 1.44), but not CHD (HR 1.11, 95% CI 0.97, 1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk. Conclusions: Compared to persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.