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Cardiovascular Disease Mortality Patterns Among People With Cancer in New South Wales, Australia: A Population-Wide
Md Mijanur Rahman1,2, Karen Canfell3, Katy Bell3
1Collaboration for Cancer Outcomes Research and Evaluation (CCORE), School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia.
Objective:
To investigate cardiovascular disease (CVD) mortality patterns among people with cancer in New South Wales (NSW) compared to the NSW general population and trends over time.
Design:
Population-wide retrospective data-linkage study.
Participants And Setting:
873,344 people aged ≥ 40 diagnosed with primary invasive cancer and registered in the NSW Cancer Registry between 1985 and 2019.
Main Outcomes:
CVD as the underlying cause of death. Absolute mortality rate (AMR, per 10,000 person-years) and standardised mortality ratios (SMR) compared to the NSW general population.
Results:
Of 514,865 people with cancer who died between 1985 and 2020, 71% (n = 303,770) died from cancer and while 14% (n = 73,733) from CVD. AMR of CVD increased with time since cancer diagnosis (≤ 2 years: AMR = 124 vs. > 10 years: AMR = 152) and declined from 188 in 1985-1995 to 68 in 2010-2020 following cancer diagnosis in 1985-1989 and 2010-2014, respectively. Approximately 45% of CVD deaths were due to ischaemic heart disease, with 49% in males versus 40% in females. Elevated SMRs of CVD were found for ≤ 2 years after cancer diagnosis (SMR = 1.17, 95% CI: 1.15, 1.19), those aged 40-59 (SMR = 1.13, 95% CI: 1.07, 1.19) and those diagnosed with distant metastases (SMR = 1.31, 95% CI: 1.27, 1.35) or lung cancer (SMR = 1.42, 95% CI: 1.37, 1.47). Lower CVD SMRs were observed for > 2 years after cancer diagnosis (e.g., for 2-5 years: SMR = 0.84, 95% CI: 0.83, 0.86), among people diagnosed with cancers with higher survival rates (e.g., Melanoma: SMR = 0.79, 95% CI: 0.78, 0.81) and in the most recent period 2010-2020 (SMR = 0.85, 95% CI: 0.83, 0.87).
Conclusion:
Higher than expected CVD mortality compared to the general population was observed within the first few years after cancer diagnosis, especially among those diagnosed with lung cancer and distant metastases, which might reflect shared risk factors and cardiotoxic treatment. Our findings underscore the need for CVD risk assessment, prevention, and care among people with cancer.
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