Temporal Trend of Cardiovascular Disease Burden Among Cancer Patients Between 2005 and 2022: Nationwide Population-Based Cohort Study in South Korea

BACKGROUND AND OBJECTIVES: Comprehensive data on the changing landscape of cardiovascular disease (CVD) burden in cancer patients remains limited. We aimed to analyze the temporal trend in the burden of CVD among cancer patients. METHODS: Using a nationwide administrative claims database in Korea, we analyzed 1,322,502 adults (aged ≥18) newly diagnosed with cancer (2005-2022). The primary outcomes were: 1) temporal trends in CVD incidence, including ischemic heart disease (IHD), heart failure (HF), and stroke; and 2) cause-specific mortality trends, focusing on cancer and CVD-related deaths. Both crude and age-standardized rates were calculated for CVD incidence and mortality. RESULTS: The 1-year age-standardized cancer mortality rate showed a substantial decline from 134.0 to 76.3 per 1,000 person-years. While the age-standardized 1-year CVD incidence initially decreased from 91.7 to 50.6 per 1,000 person-years (2005-2014), this improvement plateaued and showed an upward trend thereafter. Analysis of CVD subtypes revealed divergent patterns: age-standardized IHD incidence declined, while HF incidence rose by 136%, 52%, and 37% at 1-, 3-, and 5-year follow-ups. Despite improvements in cancer mortality, the proportion of deaths attributed to CVD increased from 1.0% to 1.5% at 1-year, corresponding to a 50% relative rise and showed a similar upward trend at 5-year follow-up, with HF emerging as an increasingly cause of cardiovascular death (increasing from 10.8% to 26.3% of CVD mortality). CONCLUSIONS: While cancer-specific mortality has improved significantly, cardiovascular mortality remains a growing concern, due to the increasing burden of HF in cancer patients. Ongoing CVD pattern surveillance in cancer patients is crucial for targeted interventions and prevention.