Abstract Body (Do not enter title and authors here): Background Evidence linking cancer diagnosis to risk of incident atherosclerotic cardiovascular disease (ASCVD) remains inconclusive.
Research Questions Do cancer patients experience a higher risk of ASCVD independent of shared risk factors? How does the risk of ASCVD evolve over time following a cancer diagnosis?
Aims To determine the association between cancer diagnosis and subsequent risk of ASCVD (coronary heart disease and stroke), and its trajectory over time after cancer diagnosis.
Methods We prospectively followed 108,689 women in the Nurses’ Health Study (NHS) (1984-2020), 113,608 women in the NHSII (1991-2019) and 45,327 men from the Health Professionals Follow-up Study (HPFS) (1986-2016) who were free of ASCVD and cancer at baseline. We conducted multivariable-adjusted time-varying Cox proportional hazards models to assess ASCVD risk following individual cancer diagnosis. We conducted restricted cubic spline analyses to assess the varied ASCVD risk over time after cancer diagnosis.
Results During up to 36 years of follow-up, 48,069 incident cancer cases and 32,592 ASCVD cases were documented. After adjusting for shared risk factors, ASCVD risk was significantly elevated after diagnosis of cervical cancer (HR: 1.63; 95%CI: 1.10-2.42) and Hodgkin lymphoma (HR: 2.17; 95%CI: 1.42-3.30) compared with non-cancer participants. Prostate cancer diagnosis was associated with a lower ASCVD risk (HR: 0.91; 95% CI: 0.85-0.97). Breast cancer diagnosis was associated with decreased ASCVD risk during the first 15 years after diagnosis, but this risk gradually increased afterward (P =0.02). Bladder cancer was associated with increased ASCVD risk during the first 10 years and attenuated afterward (P=0.03). The risk of ASCVD increased over time after cancer diagnosis among patients with cancers of colorectum (P=0.003), lung (P=0.007), and endometrium (P=0.05). No significant association with ASCVD risk was observed for cancers of oral cavity and pharynx, sarcoma, melanoma, kidney, thyroid, leukemia, or ovary. Results were consistent across sensitivity analyses.
Conclusions Increased ASCVD risk was observed for patients diagnosed with cervical cancer or Hodgkin lymphoma, independent of shared risk factors. ASCVD risk trajectories varied over time after diagnosis according to different cancer types. These findings support a need for tailored ASCVD screening among cancer survivors based on specific cancer types and post-diagnosis durations.