Pre‐Existing and Post‐Cancer Major Cardiovascular Disease and Their Association With Mortality Outcomes Among Cancer Survivors in Australia
Md Mijanur Rahman, Katy Bell, Grace Joshy, Michael David, Karen Canfell, David Goldsbury, Bogda Koczwara, Emily Banks, Kazuaki Negishi, Geoff P. Delaney, Mei Ling Yap, Xue Qin YuABSTRACT
Background
As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population‐level evidence on the burden of pre‐existing and post‐cancer CVD remains limited. This study aims to quantify pre‐existing and post‐cancer newly documented major CVD and their association with mortality outcomes among people with cancer.
Methods
Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006 to 2016. The cohort was followed up until 31 December 2021. Fine‐Grey modelling estimated sub‐distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers.
Results
Overall, 18% ( n = 62,675) of participants had pre‐existing CVD within 5 years before cancer diagnosis, varying by age (3% for age < 50 vs. 40% for ≥ 80). Of those without pre‐existing CVD ( n = 281,661), 27% ( n = 76,924) had post‐cancer newly documented CVD, with the highest age‐standardised incidence rates in pancreatic cancer (716 per 10,000 person‐years), followed by lung (657). The median follow‐up period was 6.8 years with an interquartile range: 2.1–10.3 The sHR of pre‐existing CVD for cancer mortality ranged from 0.99 (95% CI: 0.85–1.13) in cancer of kidney to 1.81 (95% CI = 1.71–1.91) in lymphoma, and for cardiovascular mortality, 1.98 (1.78–2.18) in lymphoma to 4.74 (4.39–5.09) in pancreatic cancer. The sHR of post‐cancer newly documented CVD for cancer mortality, ranging from 0.87 (95% CI: 0.69–1.05) in liver cancer to 2.33 (95% CI = 2.04–2.62) in cervical cancer and cardiovascular mortality, ranging from 1.45 (95% CI: 1.18–1.72) in myeloma to 3.39 (95% CI = 2.90–3.88) in liver cancer.
Conclusion
CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all‐cause mortality. Population‐based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.