Persistent Cardiovascular Burden and Independent Association Among Cancer Survivors in the United States, 2016 to 2024.

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of morbidity among cancer survivors. However, contemporary trends and independent association between cancer survivorship and prevalent CVD remain incompletely characterized.

METHODS

Using 2016 to 2024 Behavioral Risk Factor Surveillance System data, we analyzed 2 nationally representative cohorts of US adults. A trend cohort (n=3 642 415) assessed age-standardized CVD prevalence via Joinpoint regression. An association cohort (n=829 958) isolated the association between cancer survivorship and CVD using inverse probability of treatment weighting.

RESULTS

From 2016 to 2024, age-standardized CVD prevalence among cancer survivors was persistently double that of the general population (12.9%-15.0% versus 6.8%), with no significant temporal decline. In unadjusted analysis to determine the absolute burden, survivors had 11.7% higher CVD prevalence than controls. After inverse probability of treatment weighting adjustment, a significant absolute prevalence difference of 3.0% persisted. Consequently, cancer survivorship was independently associated with prevalent CVD (odds ratio [OR], 1.22 [95% CI, 1.18-1.27=; E-value=1.76). Associations were stronger among survivors aged <65 years (OR, 1.82 [95% CI, 1.58-2.08]) and those without traditional metabolic comorbidities (OR, 1.71 [95% CI, 1.50-1.95]). Site-specific analyses revealed robust independent associations for prostate and colorectal cancers, whereas associations observed for breast and lung cancers were largely attenuated after adjustment for age and smoking-related factors, respectively.

CONCLUSIONS

The CVD burden among US cancer survivors remains persistently high. Independent of traditional factors, cancer survivorship is associated with a distinct cardiovascular burden, particularly among younger individuals and those with a low-risk metabolic profile. These findings support extending cardiovascular surveillance to conventionally low-risk subgroups.