Cardiovascular risk after cancer in patients with ischemic heart disease or peripheral artery disease.

BACKGROUND

Patients with ischemic heart disease (IHD) or peripheral artery disease (PAD) represent a high-risk cardiovascular phenotype. When cancer is diagnosed in this population, clinical attention may shift toward treatment of the malignancy, potentially leading to under-recognition of pre-existing cardiovascular disease and its associated risks. Real-world data describing early cardiovascular outcomes after cancer diagnosis in this subgroup are however limited. The objective was to describe 1-year risks of cardiovascular death, major adverse cardiovascular events (MACE: ischemic stroke, systemic embolism, myocardial infarction, and hemorrhagic stroke), and venous thromboembolism (VTE: pulmonary embolism, and deep vein thromboembolism) after cancer diagnosis and to compare these risks across cancer sites within this high-risk vascular population.

METHODS

Using nationwide Danish registries, we identified 91,253 patients with IHD and/or PAD who developed a first primary cancer between 2002 and 2022. One-year cumulative incidences of cardiovascular death, MACE, and VTE were estimated using competing-risk methods. Multivariable Cox regression models were used to identify clinical predictors of cardiovascular outcomes.

RESULTS

Within one year of cancer diagnosis, 33% of patients died. The cumulative incidence of cardiovascular death was 2.4%, MACE 2.8%, and VTE 1.8%, with substantial variation across cancer types. Neurologic, respiratory, and digestive tract cancers were associated with the highest cardiovascular risk. Prior cardiovascular comorbidity strongly predicted adverse outcomes. Statin therapy was associated with lower cardiovascular mortality (hazard ratio [HR] 0.66) and fewer MACE events (HR 0.84).

CONCLUSIONS

Cancer patients with pre-existing IHD or PAD experience a high burden of early cardiovascular and thrombotic events with marked variation across cancer types. These findings underscore the need for integrated cardio-oncology care and support continued use of guideline-directed cardiovascular preventive therapies during cancer treatment.