Temporal trends and emerging burden of cardiovascular disease in cancer patients: A nationwide study from 2005 to 2022

Abstract Background Cancer and cardiovascular disease (CVD) share overlapping risk factors and pathophysiological mechanisms, leading to an intricate interplay between these conditions. Advances in cancer treatment have improved survival rates, but the growing population of cancer survivors faces a substantial burden of CVD. Objective This study aimed to evaluate temporal trends in the incidence and mortality of CVD among cancer patients, with a focus on changes in the patterns of CVD subtypes, including ischemic heart disease (IHD), heart failure (HF), and stroke, over the period 2005–2022. Methods We utilized data from the Korean National Health Insurance Service database to identify 1,322,502 adult cancer patients newly diagnosed between 2005 and 2022. Incidence and mortality rates for CVD subtypes were calculated at 1-, 3-, and 5-year intervals. Trends in age-standardized rates were analyzed, and the impact of pre-existing and newly developed CVD on mortality outcomes was assessed using multivariate analyses. Results The age-standardized 1-year CVD incidence rate decreased from 91.7 per 1,000 person-years in 2005 to 50.6 in 2014 but showed an upward trend thereafter (Figure 1). While IHD and stroke incidence declined over time, HF incidence increased significantly (1-year incidence: +26%). CVD mortality remained stable (Figure 2), with HF accounting for an increasing proportion of CVD-related deaths (1-year: from 12.1% to 32.6%). Cancer patients with pre-existing or newly developed CVD had significantly higher all-cause, cancer-specific, and CVD mortality than those without CVD. Conclusion Despite early improvements, the declining trend in CVD incidence among cancer patients has plateaued, and HF has emerged as a growing challenge. Enhanced cardio-oncology collaboration, early cardiovascular risk stratification, and targeted interventions are critical to reducing the burden of CVD and improving long-term outcomes in cancer patients.Temporal trends in 1-year cardiovascular Temporal change in the proportion of 1-y