Risk of atherosclerotic cardiovascular disease after cancer diagnosis: findings from 3 prospective cohort studies

BACKGROUND: We sought to determine the association between cancer diagnosis and subsequent risk of atherosclerotic cardiovascular disease (ASCVD) and examine the trajectory of the association over time after cancer diagnosis. METHODS: We prospectively followed 108 689 women in the Nurses' Health Study (1984-2020), 113 569 women in the Nurses' Health Study II (1991-2019), and 45 328 men in the Health Professionals Follow-Up Study (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 an individual's cancer diagnosis. RESULTS: During up to 36 years of follow-up, 4334 new-onset ASCVD events among 49 603 incident cancer cases were documented. After adjusting for shared risk factors, cervical cancer (hazard ratio [HR] = 1.56, 95% confidence interval [CI] = 1.06 to 2.29) and Hodgkin lymphoma (HR = 2.80, 95% CI = 1.89 to 4.15) was associated with increased risk of ASCVD incidence, whereas prostate cancer was associated with a lower ASCVD incidence (HR = 0.91, 95% CI = 0.85 to 0.97). Compared with cancer-free individuals, breast cancer survivors experienced lower ASCVD risk during the first 7.5 years, but risk gradually increased afterward (Pnonlinearity = .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 statistically significant association with ASCVD risk was observed for cancers of the oral cavity and pharynx, kidney, or ovary; sarcoma; melanoma; or leukemia. CONCLUSIONS: Cervical cancer and Hodgkin lymphoma were associated with an increased risk of new-onset ASCVD, independent of shared risk factors. No increased risk was found with other cancers. Risk trajectories of ASCVD varied over time after diagnosis by cancer type.