Key result
Major CVD in cancer survivors is linked to ~34-point higher all-cause mortality.
Why the study?
As cancer survival improves, cardiovascular disease has emerged as a major competing cause of death, but population-level evidence on the burden of pre-existing and post-cancer CVD and their association with mortality outcomes remained limited.
Does pre-existing or post-cancer newly documented major cardiovascular disease increase the risk of cancer, cardiovascular, and all-cause mortality in adult cancer survivors?
Cohort (n=344,336)
Yes
Does pre-existing or post-cancer newly documented major cardiovascular disease increase the risk of cancer, cardiovascular, and all-cause mortality in adult cancer survivors?
This large Australian population-based linkage study demonstrates that nearly one in five cancer patients have pre-existing major CVD and over one in four without prior CVD develop it post-diagnosis, with both strongly linked to elevated cancer-specific, cardiovascular, and all-cause mortality, underscoring the need for integrated cardio-oncology care.
CVD presence signals elevated mortality in cancer survivors; extends observational competing-risk data but leaves causal effects and practice change open.
Background As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population‐level evidence on the burden of pre‐existing and post‐cancer CVD remains limited. This study aims to quantify pre‐existing and post‐cancer newly documented major CVD and their association with mortality outcomes among people with cancer. Methods Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006 to 2016. The cohort was followed up until 31 December 2021. Fine‐Grey modelling estimated sub‐distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers. Results Overall, 18% ( n = 62,675) of participants had pre‐existing CVD within 5 years before cancer diagnosis, varying by age (3% for age < 50 vs. 40% for ≥ 80). Of those without pre‐existing CVD ( n = 281,661), 27% ( n = 76,924) had post‐cancer newly documented CVD, with the highest age‐standardised incidence rates in pancreatic cancer (716 per 10,000 person‐years), followed by lung (657). The median follow‐up period was 6.8 years with an interquartile range: 2.1–10.3 The sHR of pre‐existing CVD for cancer mortality ranged from 0.99 (95% CI: 0.85–1.13) in cancer of kidney to 1.81 (95% CI = 1.71–1.91) in lymphoma, and for cardiovascular mortality, 1.98 (1.78–2.18) in lymphoma to 4.74 (4.39–5.09) in pancreatic cancer. The sHR of post‐cancer newly documented CVD for cancer mortality, ranging from 0.87 (95% CI: 0.69–1.05) in liver cancer to 2.33 (95% CI = 2.04–2.62) in cervical cancer and cardiovascular mortality, ranging from 1.45 (95% CI: 1.18–1.72) in myeloma to 3.39 (95% CI = 2.90–3.88) in liver cancer. Conclusion CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all‐cause mortality. Population‐based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.
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Rahman et al. (2026) conducted a cohort in Primary invasive cancer (n=344,336). Pre-existing major cardiovascular disease (within 5 years before cancer diagnosis) and post-cancer newly documented major cardiovascular disease vs. Patients with primary invasive cancer without pre-existing or post-cancer newly documented major cardiovascular disease was evaluated on All-cause, cancer-specific, and cardiovascular mortality (reported across 20 cancer types; values shown for any malignancy all-cause death rate by pre-existing CVD status). Pre-existing (18%) and post-cancer newly documented major CVD (27%) were associated with higher all-cause (72% vs 38%), cancer (48% vs 30%), and CVD mortality (11% vs 5%) in cancer survivors.
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