The risk of death from cardiovascular causes may be higher among patients diagnosed with colorectal cancer compared with the general population, according to new findings presented by Ayaz et al at the American College of Cardiology (ACC) Annual Scientific Session 2025.
Background
Cardiovascular disease is the leading cause of mortality globally, and many studies have shown that patients with cancer experience an increased risk of cardiovascular-related issues. A previous study, published by Florido et al in JACC, found that cancer survivors had a 37% increased risk of cardiovascular disease. However, there have been few studies exploring the relationship between cardiovascular mortality and colorectal cancer. With colorectal cancer on the rise in the United States, it may be critical to understand the rates of cardiovascular mortality and assess how risk changes over time.
Study Methods and Results
In the study, investigators used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database to analyze the outcomes of over 630,000 U.S. adult patients diagnosed with colorectal cancer between 2000 and 2021. They defined cardiovascular mortality as any deaths attributed to cardiovascular disease, hypertension, stroke and other cerebrovascular diseases, atherosclerosis, or a tear or aneurysm in the aorta.
The investigators discovered that patients with colorectal cancer were 16% more likely to die of cardiovascular causes compared with individuals without colorectal cancer. They noted that the risk was especially pronounced within the first 2 years following a colorectal cancer diagnosis, with a 45% increased risk. The elevated risks were also prevalent among those younger than 50 years, who were 2.4 times more likely to die from cardiovascular causes compared with individuals in the same age group who didn’t have colorectal cancer. Further, Black patients and male patients with colorectal cancer faced a 74% and 55% increased risk of cardiovascular mortality, respectively, compared with those in the general population.
The investigators proposed that the disparities observed in the study could stem from multiple factors such as differences in socioeconomic status, geographic location, or access to care and warrant further study and attention. They suggested that the heightened risk of cardiovascular mortality could arise from side effects of cancer treatment, from the cancer itself and the inflammatory processes it causes, or from other causes or a combination of causes.
Conclusions
Although the factors contributing to the link were not apparent, the investigators emphasized that their findings indicated a critical need for increased awareness of cardiovascular health during cancer treatment—particularly among Black patients, male patients, and those younger than 50 years at the time of their colorectal cancer diagnosis.
“Based on our findings, the 2-year period after a colorectal cancer diagnosis is a critical period when patients need aggressive care to improve cardiovascular outcomes,” underscored lead study author Ahsan Ayaz, MD, an internal medicine resident at Montefiore St. Luke's Cornwall Hospital in Newburgh, New York. “For example, there should be an aggressive approach to control cardiovascular risk factors and comorbidities like diabetes and hypertension. There is also a need for coordination between oncology teams and primary care teams, because most of those risk factors are managed by primary care providers,” he added.
The investigators plan to conduct a systematic review and meta-analysis to assess trends in cardiovascular mortality among patients receiving different cancer therapies. As a result of the disparities identified in the study, they stressed the need to further evaluate the potential role of factors such as socioeconomic status, insurance status, and health-care access in clinical trials for colorectal cancer.
“For therapies that are newer, there is not a lot of data on the side effects and toxicities, but evidence is emerging that they cause cardiovascular toxicity. It is important to identify these problems promptly and take steps to mitigate them,” Dr. Ayaz concluded.
Disclosure: For full disclosures of the study authors, visit accscientificsession.acc.org.
