Cervical Cancer, Hodgkin Lymphoma Increase ASCVD Risk

New prospective cohort research has found that cervical cancer or Hodgkin lymphoma was associated with an increased risk of new-onset atherosclerotic cardiovascular disease (ASCVD), independent of shared risk factors, while no increased risk was found with other cancers.1

“Many deaths among cancer patients are not attributed to cancer itself, but ASCVD. It has been hypothesized that both cancer and CVD share pathways of systematic inflammation and oxidative stress and that cancer treatment might increase CVD risk. Recently, several studies suggested elevated risk of composite CVD (including heart failure [HF]) among cancer patients independent of shared risk factors.2 Such an association, if confirmed, has important implications for both clinical practice and basic medical sciences. It raises questions regarding CVD screening, treatment dosing options, and the inclusion of cancer in CVD risk models,” study investigator Qiang Liu, MD, Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, and colleagues wrote.1

Liu and colleagues prospectively followed 108,689 women in the Nurses’ Health Study (NHS) (1984–2020), 113,569 women in the NHSII (1991–2019), and 45,328 men in the Health Professionals Follow-up Study (HPFS; 1986–2016) without ASCVD and cancer at baseline. They assessed ASCVD risk following individual cancer diagnosis by use of multivariable-adjusted time-varying Cox proportional hazards regression models.

Overall, there were 4,334 new-onset ASCVD events among 49,603 incident cancer cases during the 36 years of follow-up. Liu and colleagues found that after adjusting for shared risk factors, cervical cancer (HR, 1.56; 95% CI, 1.06–2.29) and Hodgkin lymphoma (HR, 2.80; 95% CI, 1.89–4.15) was associated with increased risk of ASCVD incidence, while prostate cancer was associated with a lower ASCVD incidence (HR, 0.91; 95% CI, 0.85–0.97).

The investigators also found that breast cancer survivors, compared to cancer-free individuals, had a lower ASCVD risk during the first 7.5 years but gradually increased afterwards (Pnon-linearity=0.01). Over time, the risk of ASCVD increased among patients with colorectum (P = .003), lung (P = .002), and endometrium (P = .04) cancers. They did not observe any significant association with ASCVD risk with cancers of the oral cavity and pharynx, sarcoma, melanoma, kidney, thyroid, leukemia, or ovary. Those with bladder cancer patients had increased ASCVD risk between approximately 5 and 12 years after diagnosis, with a peak around the 10th year and then gradually attenuated to an inverse association. Overall, for all cancer types surveyed, survivors’ risk of ASCVD initially decreased during the first 5 years following diagnosis but gradually evolved into an increased risk afterward.

“Contrasting with prior studies suggesting that cancer survivors are at an increased risk of composite CVD (including HF), our findings showed only specific cancer sites may be considered as independent risk factors in current equations to predict ASCVD and offered novel insights that certain cancer treatments following cancer diagnosis may have driven the cancer-specific patterns for ASCVD development. Clinicians managing cardiovascular risk for specific cancer survivors should be aware of the timing of risk, cancer treatments and CVD subtypes,” Liu and colleagues wrote.1

REFERENCES
  1. Liu Q, Wang Q, Wang K, et al. Risk of atherosclerotic cardiovascular disease after cancer diagnosis: findings from 3 prospective cohort studies. J Natl Cancer Inst. 2025;117(8):1707-1716. doi:10.1093/jnci/djaf122
  2. Florido R, Daya NR, Ndumele CE, et al. Cardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk In Communities (ARIC) Study. J Am Coll Cardiol. 2022;80(1):22-32. doi:10.1016/j.jacc.2022.04.042

Continue Reading