Risk of atherosclerotic cardiovascular disease after cancer diagnosis: findings from 3 prospective cohort studies.

BACKGROUND

We sought to determine the association between cancer diagnosis and subsequent risk of atherosclerotic cardiovascular disease (ASCVD) and examine the trajectory of the association over time after cancer diagnosis.

METHODS

We prospectively followed 108 689 women in the Nurses' Health Study (1984-2020), 113 569 women in the Nurses' Health Study II (1991-2019), and 45 328 men in the Health Professionals Follow-Up Study (1986-2016) who were free of ASCVD and cancer at baseline. We conducted multivariable-adjusted, time-varying Cox proportional hazards regression models to assess ASCVD risk following an individual's cancer diagnosis.

RESULTS

During up to 36 years of follow-up, 4334 new-onset ASCVD events among 49 603 incident cancer cases were documented. After adjusting for shared risk factors, cervical cancer (hazard ratio [HR] = 1.56, 95% confidence interval [CI] = 1.06 to 2.29) and Hodgkin lymphoma (HR = 2.80, 95% CI = 1.89 to 4.15) was associated with increased risk of ASCVD incidence, whereas prostate cancer was associated with a lower ASCVD incidence (HR = 0.91, 95% CI = 0.85 to 0.97). Compared with cancer-free individuals, breast cancer survivors experienced lower ASCVD risk during the first 7.5 years, but risk gradually increased afterward (Pnonlinearity = .01). The risk of ASCVD increased over time among patients with cancers of the colorectum (P = .003), lung (P = .002), and endometrium (P = .04). No statistically significant association with ASCVD risk was observed for cancers of the oral cavity and pharynx, kidney, or ovary; sarcoma; melanoma; or leukemia.

CONCLUSIONS

Cervical cancer and Hodgkin lymphoma were associated with an increased risk of new-onset ASCVD, independent of shared risk factors. No increased risk was found with other cancers. Risk trajectories of ASCVD varied over time after diagnosis by cancer type.