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

Abstract

Background To determine the association between cancer diagnosis and subsequent risk of ASCVD, and to examine the trajectory of the association over time after cancer diagnosis. Methods We prospectively followed 108,689 women in the Nurses’ Health Study (NHS) (1984-2020), 113,569 women in the NHSII (1991-2019), and 45,328 men in the Health Professionals Follow-up Study (HPFS) (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 individual cancer diagnosis. Results During up to 36 years of follow-up, 4,334 new-onset ASCVD events among 49,603 incident cancer cases were documented. After adjusting for shared risk factors, cervical cancer (HR: 1.56; 95%CI: 1.06-2.29) and Hodgkin lymphoma (HR: 2.80; 95%CI: 1.89-4.15) was associated with increased risk of ASCVD incidence, while prostate cancer was associated with a lower ASCVD incidence (HR: 0.91; 95% CI: 0.85-0.97). Compared to cancer-free individuals, breast cancer survivors experienced lower ASCVD risk during the first 7.5 years but gradually increased afterwards (Pnon-linearity=0.01). The risk of ASCVD increased over time among patients with cancers of the colorectum (P = .003), lung (P = .002), and endometrium (P = .04). No significant association with ASCVD risk was observed for cancers of the oral cavity and pharynx, sarcoma, melanoma, kidney, thyroid, leukemia, or ovary. Conclusions Cervical cancer or Hodgkin lymphoma was associated with an increased risk of new-onset ASCVD, independent of shared risk factors, while no increased risk was found with other cancers. ASCVD risk trajectories varied over time after diagnosis according to cancer types.