NEW-ONSET AND PRE-EXISTING CARDIOVASCULAR COMORBIDITIES AND SURVIVAL OF LUNG CANCER PATIENTS IN KOREA

Abstract

Therapeutic Area

ASCVD/CVD in Special Populations

Background

Lung cancer patients exhibit the highest incidence of cardiovascular comorbidities among all cancer types. However, the impact of the timing of cardiovascular disease (CVD) onset on mortality risk in lung cancer patients remains unclear. This study aimed to assess the role of pre-existing and new-onset CVD in survival of patients with non-small cell lung cancer (NSCLC).

Methods

3,144 patients with non-small cell lung cancer (NSCLC) who visited the National Cancer Center in Korea (2012-2017) were analyzed. CVD status was categorized into “none”, “pre-existing”, and “new-onset”, defined by hospitalization for myocardial infarction (I21–I23, MI), ischemic stroke (I63, G45, STR), or heart failure (I50, HF) within 1 year before or after NSCLC diagnosis, using the International Classification of Diseases, 10th Revision (ICD-10). Cox regression analysis using landmark approach (1 year landmark period) and A time-dependent Cox regression analysis were performed to confirm the consistency of the results. Furthermore, the pre-existing group was subdivided into “stable pre-existing” (CVD diagnosed only before cancer) and “recurrent” (CVD events recurring after cancer diagnosis) groups.

Results

Of 3,144 NSCLC patients (mean age 64.2 years; 36.9% women), 92.8% had no CVD, 3.6% had pre-existing CVD, and 3.7% had new-onset CVD. Mortality was highest in the new-onset group (61.7%), followed by pre-existing (54.5%), and none (47.8%). New-onset CVD was associated with increased mortality risk compared to non-CVD group (adjusted Hazard Ratio [aHR]: 1.90, 95% Confidence Interval [CI]: 1.47-2.45), In contrast, the pre-existing or recurrent CVD groups did not show a significant increase in mortality risk. This pattern was consistent across each CVD component analyzed. Moreover, time-dependent Cox regression analysis produced consistent results, thereby supporting the robustness of the findings. Additionally, the highest mortality risk in the new-onset group occurred at 1 year (aHR: 2.29, 95% CI: 1.65-3.18). Subgroup analysis revealed heterogeneity in mortality risks among women, patients with BMI <25 kg/m², and smokers.

Conclusions

Among patients with NSCLC, new-onset CVD was strongly associated with increased mortality, particularly within the first year after diagnosis. These findings highlight the critical importance of early cardiovascular risk detection and proactive management in NSCLC patients, underscoring the need for integrated cardio-oncology approaches.