Increased Risk of Cardiovascular Disease Among Survivors of Some Adult-Onset Cancers


Key Points

  • Multiple myeloma, lung/bronchus cancer, non-Hodgkin lymphoma, and breast cancer were associated with an increased risk of cardiovascular disease.
  • Overall survival was poorer among cancer survivors with cardiovascular disease.

In a study using managed-care organization data reported in the Journal of Clinical Oncology, Armenian et al found that survivors of adult-onset multiple myeloma, non-Hodgkin lymphoma, lung/bronchus cancer, and breast cancer had an increased risk for subsequent cardiovascular disease.

Study Details

This community-based retrospective cohort study involved data from 36,232 patients in the Kaiser Permanente Southern California integrated managed-care organization who were diagnosed with cancer at age ≥ 40 years and had survived at least 2 years. Patients were matched for age, sex, and zip code with 73,545 noncancer controls. Cancer survivors were more likely than controls to have hypertension, diabetes, and dyslipidemia and to be overweight/obese and have a history of smoking. Cardiovascular disease was defined as ischemic heart disease, stroke, or cardiomyopathy/heart failure.

Cardiovascular Disease Risk

On multivariate analysis adjusting for age, sex, race/ethnicity, diabetes, hypertension, dyslipidemia, smoking, and overweight/obesity, survivors of multiple myeloma (incidence rate ratio [IRR] = 1.70, P < .01), carcinoma of the lung/bronchus (IRR = 1.58, P < .01), non-Hodgkin lymphoma (IRR = 1.41, P < .01), and breast cancer (IRR = 1.13, P < .01) had a significantly higher risk of cardiovascular disease than controls. Survivors of prostate cancer had a significantly lower risk (IRR = 0.89, P < .01). The risk was not significantly increased among survivors overall (IRR = 1.02, P  = .17).

Compared with controls with fewer than two cardiovascular risk factors, the risk of cardiovascular disease was highest in survivors with more than two risk factors (IRR = 1.83–2.59, P < .01, for breast, kidney, lung/bronchus, and ovarian cancer and multiple myeloma and non-Hodgkin lymphoma). Among cancer survivors, 8-year overall survival was 60% among those developing cardiovascular disease vs 81% in those not developing cardiovascular disease (P < .01).

The investigators concluded: “The magnitude of subsequent [cardiovascular] risk varies according to cancer subtype and by the presence of [cardiovascular risk factors]. Overall survival in survivors who develop cardiovascular disease is poor, emphasizing the need for targeted prevention strategies for individuals at highest risk of developing cardiovascular disease.”

Saro H. Armenian, DO, MPH, of City of Hope Comprehensive Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.