Long-Term Atherosclerotic Cardiovascular Disease Risk in Patients With Cancer: A Population-Based Study

The long-term risk of incident atherosclerotic cardiovascular diseases (ASCVD) among cancer patients remains incompletely defined. This study aimed to evaluate the long-term ASCVD risk in cancer patients compared with the noncancer population. This was a prospective population-based study using data from the Kailuan cohort, 6204 individuals with newly diagnosed cancer, free of ASCVD, were matched in a 1:1 ratio to noncancer controls for age (±1) and sex, from June 2006 to December 2020. Multivariable competing risk analyses were performed to evaluate the association between cancer diagnosis and risk of incident ASCVD events (including myocardial infarction, ischemic stroke, heart failure, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). During a median follow-up of 5.3 (1.7, 9.7) years, 1019 incident ASCVD events were observed. Compared to participants without cancer, there was a similar risk for incident ASCVD events among cancer patients within the first few years after cancer diagnosis, and the risk declined over time. Overall, cancer patients showed lower risks of incident ASCVD compared to the noncancer patients over the long term, with a hazard ratio (95% confidence interval) of 0.52 (0.45-0.60) for composite ASCVD events, 0.43 (0.35-0.53) for ischemic stroke, 0.63 (0.42-0.95) for myocardial infarction, 0.63 (0.48-0.83) for heart failure, and 0.82 (0.60-1.11) for coronary revascularization. Baseline level of low-density lipoprotein cholesterol, fasting blood glucose, blood pressure, and high-sensitivity C-reactive protein could independently predict the incident ASCVD among the study population. Subgroup analyses according to cancer types revealed a significantly lower risk of ASCVD events among patients with digestive cancer or respiratory cancer compared with noncancer controls, but not for urologic or genital cancer. Multiple sensitivity analyses yielded similar results to the primary analysis. Long-term ASCVD risk among cancer survivors is not increased compared with the noncancer individuals, probably driven by a favorable profile of baseline risk factor in cancer population.