Abstract Body (Do not enter title and authors here): Background:
Cancer and cardiovascular disease (CVD) share risk factors including smoking, obesity, hypertension, and sedentary lifestyle. Advancements in cancer therapies have increased survivorship thereby increasing the likelihood of developing CVD among cancer survivors. Quantifying national trends in co-morbid cancer and CVD can help improve the integration of CVD prevention strategies along the cancer care continuum.

Methods:
We conducted serial, cross-sectional analyses of National Health and Nutrition Examination Survey (NHANES) participants from 2009-2020. We analyzed trends in cancer history, prevalent CVD, and prevalent predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk (categorized as >20%, 7.5-<20%, and 5-7.5%). Cancer and CVD history were defined by self-reported cancer diagnosis, and self-reported history of coronary artery disease, heart attack, angina, heart failure, or stroke, respectively. Predicted 10-year ASCVD risk was estimated using the pooled cohort equations. National estimates with 95% confidence intervals (95% CI) were calculated using NHANES survey weighting.

Results:
Of the 24,196 NHANES participants aged 18-75, 1,392 reported a history of cancer, representing a weighted prevalence of 13.5 million people. Among participants with a history of cancer, 2.3 million (17.0%; 95% CI, 14.2-19.9) had CVD. In those without CVD, 18.3% (95% CI, 15.4-21.1) had a ≥20% predicted risk, 33.8% (95% CI, 30.4-37.3) had a 7.5-<20% risk, and 9.4% (95% CI, 7.4-11.4) had a 5-7.5% risk. Among the US population, the prevalence of co-morbid cancer and CVD, as well as a 10-year ASCVD risk ≥7.5%, increased from 0.93% (95% CI, 0.64-1.34) to 1.36% (95% CI, 0.99-1.87) and 2.02% (95% CI, 1.7-2.4) to 3.06% (95% CI, 2.4-3.8) respectively, between 2009 and 2020 (Figure).

Conclusion:
The rising prevalence of co-morbid CVD and cancer, coupled with the substantial proportion of cancer survivors at high risk for ASCVD, highlights the need to better integrate care strategies and preventive measures for CVD prevention and management among cancer survivors. Coordinated management and targeted interventions could significantly improve long-term health outcomes for this complex population.