Specific Cardiovascular Mortality in Cancer Survivors: A Nationwide Population‐Based Cohort Study in Japan

BACKGROUND: Improvements in cancer survivorship have led to concern about cardiovascular disease (CVD) among cancer survivors. This study aimed to investigate CVD mortality in patients with cancer compared with the general population, with a focus on specific CVDs including ischemic heart disease, heart failure, aortic dissection, ischemic stroke, and hemorrhagic stroke. METHODS: This nationwide population-based cohort study used data from the National Cancer Registry in Japan. Patients diagnosed with cancer between January 2016 and December 2019 were included. Standardized mortality ratios (SMRs) and their 95% CIs were calculated to compare the risk of CVD mortality between patients with cancer and the general population. The SMRs were also computed for each specific CVD. RESULTS: The study included 3 972 603 patients, representing 6 212 672 person-years of follow-up. Patients with cancer had a 2.39-fold higher risk of cardiovascular death compared with the general population. The SMR was highest for nonlymphoid hematologic malignancies (4.32 95% CI, 4.15-4.50). The mortality risk varied across specific types of CVD. Nonlymphoid hematologic malignancies had the highest SMRs for ischemic heart disease (3.15 95% CI, 2.87-3.45) and heart failure (7.65 95% CI, 7.07-8.27). The SMR for aortic dissection, ischemic stroke, and hemorrhagic stroke were highest for laryngeal (3.31 95% CI, 2.29-4.79), pancreatic (5.39 95% CI, 4.79-6.05), and liver (3.75 95% CI, 3.36-4.18) cancers, respectively. CONCLUSIONS: Patients with cancer had a higher CVD mortality risk, which was prominent in nonlymphoid hematologic malignancies. The mortality risk varied considerably by cancer type and specific CVD type.