Cancer survivors have a higher risk of cardiovascular disease

Adult survivors of cancer have a higher risk of heart failure and other cardiovascular diseases (CVD) later in life than adults without cancer, according to a large study led by Johns Hopkins Medicine researchers.

The team’s findings, published in the Journal of the American College of Cardiology, build on the increasingly recognised link between cancer and heart disease, with first author Roberta Florido noting that cardiovascular disease is one of the leading causes of death among some cancer survivors. This suggests that survivors of cancer are a high-risk group that may need more aggressive CVD prevention.

The analysis used data from the Atherosclerosis Risk in Communities Study, a prospective community-based population study, initiated in 1987, of CVD and its risk factors. The study had 12,414 participants, with a mean age of 54, who were followed through 2020. Some 55% were female, 25% were Black and 3250 were diagnosed with cancer.

According to the study, adult survivors of cancer had a 42% greater risk of CVD than people without cancer. The authors found that survivors of cancer had a particularly higher risk of developing heart failure (52% higher risk), followed by stroke (22% higher risk). There were no significant differences in the risk of coronary heart disease between those with and without cancer. The study also looked at specific cancer types and found the risk of CVD is not uniform across cancers.

Although the study was not designed to pinpoint the causes of increased CVD risk among survivors of cancer, Florido said her team’s main hypothesis involves a combination of cancer and noncancer-related factors such as inflammation, oxidative stress, cardiac toxicity from specific cancer treatments, and traditional risk factors like hypertension, diabetes and obesity. While the excess risk of CVD in this group was not fully explained by traditional cardiovascular risk factors, it is still important to address these risk factors that are common in survivors of cancer.

Cardiac toxicity from cancer therapies, or negative cardiac effects of cancer therapies, may be particularly important in increasing the risk of CVD in some survivors of cancer, the researchers said. For example, survivors of breast and blood cancers had significantly higher risk of CVD, and these cancers are typically managed with a combination of chemotherapy and chest radiation that can damage the heart. Conversely, survivors of prostate cancer did not have an increased risk of CVD. These patients can be managed with active surveillance or local therapies without the risk of cardiac toxicity.

“More research is needed to better understand why cancer survivors have a greater risk of CVD and whether this is partly explained by the negative cardiac effects of some cancer therapies,” Florido said. “This could lead to more targeted preventive strategies for this population.”

“Major advances in cancer treatment mean that patients are living longer and longer; this means we now need to pay attention to other chronic diseases, especially heart disease, in cancer survivors,” added senior author Elizabeth Selvin, Professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. “Cancer survivors are a high-risk population and should be prioritised for interventions that lower the chance of heart disease later in life.”

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