Aug 2026· European Heart Journal, Supplement· 0 citations
TL;DR
The burden of pre-existing CVD at cancer diagnosis has increased substantially over the past two decades in the UK and is projected to rise further, highlighting the growing need for integrated prevention strategies and cardio-oncology services to address increasing multimorbidity in patients with cancer.
Abstract
Cancer and cardiovascular disease (CVD) are the two leading causes of morbidity and mortality worldwide and frequently coexist due to shared risk factors and overlapping pathophysiology. Pre-existing CVD at cancer diagnosis complicates treatment decisions, limits tolerance to anticancer therapies, and is associated with poorer outcomes. However, national-level evidence describing how the burden of pre-existing CVD at cancer diagnosis has evolved over time, and how it may change in the future, remains limited. Understanding these trends is important for health service planning and integrated cardio-oncology care.
To examine temporal trends in pre-existing CVD at cancer diagnosis from 2001 to 2020, assess the impact of common comorbidities and lifestyle risk factors, and project future CVD burden to 2050.
We conducted a population-based serial cross-sectional study using linked UK electronic health records, including primary care, hospital admissions, cancer registry, and mortality data. Adults newly diagnosed with breast, prostate, lung, colorectal, or haematological cancer between 2001 and 2020 were included. Pre-existing CVD and subtypes were identified prior to cancer diagnosis. Annual crude and age-standardised prevalence estimates were calculated. Temporal trends were assessed using logistic regression adjusted for age, sex, and cancer site, with stratified analyses by cancer type, sex, ethnicity, and deprivation. Sequential models evaluated the association of cardiometabolic conditions, behavioural factors, and chronic systemic comorbidities. Projections to 2050 were generated using restricted cubic spline models to estimate CVD prevalence from 2021 to 2050.
Among 773,590 patients with cancer, age-standardised prevalence of pre-existing CVD increased from 31.4% in 2001 to 39.2% in 2020. Lung and haematological cancers consistently showed the highest CVD burden, while breast cancer showed the lowest. The steepest increases were observed for heart failure, atrial fibrillation, and valvular heart disease, whereas myocardial infarction and stroke showed slower growth. Sequential modelling indicated that rising cardiometabolic and chronic systemic comorbidities were strongly associated with the observed temporal increase, while behavioural factors provided limited additional attenuation. Projections suggested that approximately half of patients may have pre-existing CVD at cancer diagnosis by 2050.
The burden of pre-existing CVD at cancer diagnosis has increased substantially over the past two decades in the UK and is projected to rise further. These findings highlight the growing need for integrated prevention strategies and cardio-oncology services to address increasing multimorbidity in patients with cancer.
BACKGROUND AND AIMS
Advances in cancer care have improved survival, increasing the importance of comorbidities at diagnosis for longer-term outcomes. Pre-existing cardiovascular disease (CVD) can complicate management and prognosis, yet its long-term trends and future burden at cancer diagnosis are unclear. This study aimed to quantify temporal trends in pre-existing CVD among patients with newly diagnosed cancer and project prevalence through 2050.
METHODS
Linked primary care, cancer registry, and hospitalization records were used to identify 773 590 adults (≥18 years) diagnosed with the five most common cancers between 2001 and 2020 in England. Serial cross-sectional analyses estimated annual crude and age-standardized prevalence of pre-existing CVD and comorbidities. Temporal trends were assessed using logistic regression adjusted for demographics and cancer type. The contributions of changes in risk factor domains were evaluated using sequential modelling, and CVD prevalence was projected to 2050 using demographic-adjusted spline models.
RESULTS
The age-standardized prevalence of pre-existing CVD rose from 31.4% [95% confidence interval (CI) 31.2-31.6] in 2001-2005 to 39.2% (95% CI 39.0-39.4) in 2016-2020, with the steepest increases in lung and haematological cancers. Valvular disease, heart failure, atrial fibrillation, and diabetes showed the largest subtype rises. Sequential modelling showed the greatest attenuation of the temporal trend after adjustment for cardiometabolic conditions and chronic comorbidities. Projection analyses suggest that, if current temporal patterns continue, approximately half of patients may present with pre-existing CVD at cancer diagnosis by 2050.
CONCLUSIONS
Pre-existing CVD at cancer diagnosis has increased substantially over 2 decades and is projected to affect nearly half of patients by 2050. These trends underscore the need for the expansion of cardio-oncology services.
A. Alshahrani, E. Kontopantelis, C. Morgan et al.· European Heart Journal· 0 citations
In this population-based cohort study, the five-year incidence of cancer following a new diagnosis of CVD was markedly high and the distribution of cancer types in this population differed from that of the general population, with a higher proportion of genitourinary cancers and a lower proportion of breast cancer.
P. Moliner, H. Morillas, A. Ricarte-Marin et al.· European Heart Journal, Supp...· 0 citations
Evaluating the occurrence of new-onset CVD in women with breast cancer undergoing chemotherapy and identifying factors associated with increased risk of cardiovascular disease highlights the need for sustained cardiovascular surveillance in breast cancer survivors.
V. Dvorovy, L. Kováčová, M. Selvek et al.· European Heart Journal, Supp...· 0 citations
– Emerging evidence has revealed that cardiovascular diseases (CVDs) identify individuals prone to developing cancer. However, the precise impact and which CVD is most associated with future cancer is not clear. Therefore, we present an up-to-date impact of CVD on cancer incidence and cancer-related mortality.
– A scoping review with a systematic approach was performed in adherence to the guidelines of Transparent Reporting of Systematic Reviews and Meta-analyses (PRISMA). Studies evaluating cancer incidence and mortality among individuals with pre-existing CVD or cardiovascular (CV) risk assessments were included. To categorize the data, sub-groups were created: 1) coronary artery disease, 2) atrial fibrillation, 3) congenital heart disease, 4) heart failure, 5) hypertension, 6) thrombosis, and 7) cardiovascular health indicators. Various predictor indices were plotted in forest plots to visualize effect of CVD or CV health indicators on cancer incidence and cancer-related mortality.
– The search strategy and screening process yielded 47 full-text articles for data-extraction. All CVDs and CV health indicators demonstrated an overall elevated risk of future cancer or cancer-related mortality (Figure 1). In the current evaluation, atrial fibrillation, congenital heart disease and thrombosis presented the strongest associations. Additionally, sex differences were subtle but present, favoring women.
– This scoping review highlights that the manifold of CVD and CV health indicators increase the risk of new-onset cancer and cancer-related mortality. Together, these findings emphasize the need for awareness of future cancer in patients with CVD as well as further in-depth studies for proper comparisons.
L. Yousif, P. Ameri, M. Vinci et al.· European Heart Journal, Supp...· 0 citations
Patients with newly diagnosed CVD present a higher risk of cancer when compared to patients without a history of prior CVD, and men show a higher risk of incident cancer over time when patients with CVD are subclassified by biological sex, when patients with CVD are subclassified by biological sex.
H. Morillas Climent, P. Moliner, A. Ricarte-Marin et al.· European Heart Journal, Supp...· 0 citations
Background Despite increasing evidence on the bi-directional association between cancer and atherosclerotic cardiovascular disease (ASCVD), less is known about differences in mortality among individuals with co-existing diseases. Objective We examined all-cause and disease-specific mortality among U.S. adults living with cancer, ASCVD, and co-existing cancer and ASCVD. Methods Among adults aged ≥18 years in the National Health Interview Survey (2005-2018) linked to the National Death Index (through December 31, 2019), we estimated multivariable-adjusted HRs (aHRs) and 95% CIs using Cox proportional hazards models. Mortality outcomes were compared across individuals with cancer alone, ASCVD alone, and co-existing conditions, relative to those with neither condition. Results Among 388,632 individuals, 1.3% had co-existing cancer and ASCVD, representing approximately 3.0 million U.S. adults annually. Over a mean follow-up of 7.2 years, co-existing disease was associated with the highest all-cause mortality (aHR, 2.45 [95% CI: 2.23-2.70]), exceeding ASCVD alone (aHR, 1.93 [1.82-2.04]) and cancer alone (aHR, 1.90 [1.77-2.04]). Co-existing disease was associated with elevated risks of both cancer mortality (aHR, 4.18 [3.48-5.03]) and cardiovascular mortality (aHR, 2.73 [2.30-3.24]). Among those living with co-existing diseases, older age (≥75 years) (aHR, 6.02 [1.97-18.37]), diabetes (aHR, 1.23 [1.03-1.46]), and current/former smoking status (aHR, 1.26 [1.07-1.49]) were associated with increased hazards of all-cause mortality. Conclusions Among community-dwelling U.S. adults living with cancer and/or ASCVD, co-existing disease was associated with substantially higher mortality. These findings highlight the elevated burden of mortality among individuals with co-existing cancer and ASCVD and underscore the importance of integrated cardio-oncology care.
Reed Mszar, Leah M. Ferrucci, D. Satti et al.· JACC: Advances· 0 citations
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