Are cancer survivors more likely to get heart disease? Certain cancer drugs can cause cardiac side effects, but when patients get past that, what’s their heart disease risk? A new study from researchers at Yale suggests that cardiovascular disease in long-term cancer survivors is mainly due to the usual risk factors and not strongly influenced by cancer treatment. “Given the limited impact of cancer-specific factors,” the authors write, “cancer-agnostic risk prediction may be adequate to predict individual cardiovascular risk.”
Cardiovascular disease, which is the leading cause of death worldwide, is also the leading cause of noncancer mortality in long-term cancer survivors. But this study found, “Among older long-term survivors of breast, prostate, colon, and rectal cancer, late cardiovascular disease (5–15 years post-diagnosis) was primarily driven by age, prior cardiovascular events, and comorbidities—not by cancer treatments or tumor characteristics,” Michaela Dinan, PhD, told Inside Precision Medicine.
Dinan is senior author of the study, a professor of epidemiology in the Yale School of Public Health, and Associate Cancer Center Director for Cancer Research Training and Education at the Yale Cancer Center.
The study included 95,100 survivors with a mean age of 74 years at diagnosis. Late heart disease occurred in 23.2% of survivors. Older age, comorbidities, and prior cardiovascular disease were associated with a higher risk of developing heart disease sooner. Cancer treatment-related factors were not associated with higher risk, except for those treated for stage 3 breast cancer or radiation plus androgen deprivation therapy for prostate cancer.
Breast, prostate, colon, and rectal cancer are four of the most common types of cancer. This study helps guide risk models for predicting which cancer patients are at highest risk of later cardiovascular disease, a key factor in precision oncology care, particularly as an increasing number of younger people develop the disease. Heart conditions covered by the study included myocardial infarction, stroke, congestive heart failure, or cardiomyopathy. In this study, the high-risk group had a three- to fourfold higher risk of sooner heart disease compared to those in the low-risk group.
This report appears this month in the Journal of the American Cancer Institute. The lead author is Sarah J. Westvold, of the Yale Cancer Outcomes, Effectiveness, Public Policy and Effectiveness Research Center. The retrospective research used data from SEER-Medicare, a linked cancer registry and claims database used in U.S.-based population-based studies of cancer.
“It is well-established that some cancer treatments are associated with cardiovascular risks or toxicity. However, what our study suggests is that specifically in older patients that survive 5+ years without evidence of any CVD, that for this population—the cancer treatment they received no longer appears to be a major driver of their overall cardiovascular risk,” added Dinan.
Future areas of research she listed are: How do these findings apply to younger survivors or those treated more aggressively? What is the role of lifestyle factors and medications (e.g., statins, antihypertensives) in modifying risk? Whether integrated survivorship care models improve cardiovascular outcomes? How do social determinants of health influence long-term cardiovascular risk?
The rise of cancer among young people has become an increasing priority. Called early-onset, or young, cancer, these cases are when diagnosis happens in adults between the ages of 18 and 49. This trend is particularly worrying because until now, age has been a top risk factor for cancer. Between 1990 and 2019, the global incidence of early-onset cancer increased by 79.1% and the number of early-onset cancer deaths increased by 27.7%.
