Cardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk In Communities (ARIC) Study

Roberta Florido*, Natalie R. Daya, Chiadi E. Ndumele, Silvia Koton, Stuart D. Russell, Anna Prizment, Roger S. Blumenthal, Kunihiro Matsushita, Yejin Mok, Ashley S. Felix, Josef Coresh, Corinne E. Joshu, Elizabeth A. Platz, Elizabeth Selvin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Background: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking. Objectives: The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study. Methods: We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD. Results: Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk. Conclusions: Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.

Original languageEnglish
Pages (from-to)22-32
Number of pages11
JournalJournal of the American College of Cardiology
Issue number1
StatePublished - 5 Jul 2022


FundersFunder number
Maryland Cigarette Restitution Fund
National Institutes of Health
U.S. Department of Health and Human Services75N92022D00003, 75N92022D00004, 75N92022D00001, 75N92022D00002, 75N92022D00005
National Heart, Lung, and Blood Institute
National Cancer InstituteP30 CA006973, T32HL007024, U01CA164975
National Institute of Diabetes and Digestive and Kidney DiseasesR01 DK089174, K24 HL152440, R01 HL146907
American Heart Association20SFRN35120152


    • cancer
    • cardio-oncology
    • cardiovascular disease
    • epidemiology
    • heart failure
    • prevention


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