Abstract Body: Background: To address the growing burden of cardiovascular disease among cancer survivors, prior studies have assessed the association between cardiometabolic risk factors and mortality among individuals with cancer but have largely focused on specific cancer types or been limited by small sample sizes. We used nationally representative data to examine the relationship between cardiovascular risk factors and mortality among US cancer survivors.

Methods: We analyzed data from the National Health Interview Survey (2012-2018), linked to National Death Index, for adults aged ≥18 years with a self-reported cancer history (excluding non-melanoma skin cancer) and cardiovascular risk factors. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, obesity, smoking, and physical inactivity, categorized as low risk (0 factors), intermediate (1-2), or high (3+). Multivariable Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CI for all-cause and cancer-specific mortality.

Results: Among 15,690 cancer survivors (median age 68.0 years; 60.4% female), representing 14.8 million survivors annually, 5.3%, 38.8%, and 55.9% were at low, intermediate, and high cardiovascular risk, respectively. Cancer survivors at intermediate and high risk had a 3.1-fold (HR: 3.11, 95% CI: 2.09-4.64) and 3.6-fold (HR: 3.60, 95% CI: 2.42-5.35) increased risk of all-cause mortality compared to survivors at low risk, respectively. A similar relationship was present for cancer-specific mortality (intermediate vs. low HR: 2.53, 95% CI: 1.50-4.24; high vs. low HR: 2.44, 95% CI: 1.45-4.09).

Conclusions: In a sample of cancer survivors, most individuals were at high cardiovascular risk, which in turn was associated with an increased risk of all-cause and cancer-specific mortality. Identifying those at the highest risk as part of oncology survivorship care could impact survival among this vulnerable population.