Cancer Survivors Have Higher Risk of Cardiovascular Disease
Cancer survivors have a higher risk of developing cardiovascular disease, including heart failure and stroke, than people with no history of cancer, according to a study.
The research was published in the July 2022 issue of the Journal of the American College of Cardiology. Read the abstract of “Cardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk In Communities (ARIC) Study.”
Cardiovascular disease and breast cancer
Cardiovascular disease includes a number of conditions that affect the heart and blood vessels, some of which are caused by atherosclerosis. Atherosclerosis happens when a waxy substance called plaque builds up along the walls of the arteries — the blood vessels that carry blood away from the heart. This buildup of plaque makes the arteries narrower than they should be, which makes it harder for blood to flow through the vessels. If a blood clot forms, it can get stuck and block blood flow, which can cause a heart attack or stroke.
Other cardiovascular conditions include:
arrhythmia (abnormal heart rhythm)
heart valve problems
Cardiovascular disease can be a long-term side effect of a number of breast cancer treatments, particularly:
anthracycline chemotherapy medicines, which include Adriamycin (chemical name: doxorubicin), daunorubicin, and Ellence (chemical name: epirubicin)
Herceptin (chemical name: trastuzumab)
left-side radiation therapy, because the heart is on the left side
Research shows that seven or more years after completing breast cancer treatment, women have nearly twice the risk of dying from heart problems than women with no history of breast cancer.
About the study
Several studies have looked at links between cardiovascular disease and people who’ve received cancer treatment. Still, many of these studies were retrospective, which means:
the people who participated already had cardiovascular disease
the researchers had to look back at people’s health histories (either medical records or people’s self-reporting) to find risk factors
In this prospective study, none of the people participating had cardiovascular disease when the researchers began their work. The researchers followed different groups of people in the study to see:
if they developed cardiovascular disease
how differences between the groups affected whether or not they developed cardiovascular disease
In a prospective study, researchers watch for results, such as the development of disease, over a period of time. Many researchers feel that prospective studies offer stronger results than retrospective studies.
This study included 12,421 people who were part of the Atherosclerosis Risk In Communities (ARIC) study. The ARIC study started in 1987 and was designed to look at the risk factors for and the natural history of cardiovascular disease.
The people in the study lived in:
Washington County, Maryland
Minneapolis, Minnesota (suburbs)
Forsyth County, North Carolina
None of the people had been diagnosed with cancer or cardiovascular disease when the study started. When the people joined the study, the researchers:
took blood samples
recorded the people’s height and weight
recorded all the medicines each person was taking
asked for the people’s smoking and drinking history
The researchers collected the same samples and information every three years during the study.
When the study started:
the people’s average age was 54
55% of the people were women
25% of the people were Black and 75% were white
Between 1987 when the study started and Dec. 31, 2015, 3,250 people — 1,532 women and 1,718 men — who did not have cardiovascular disease were diagnosed with cancer. About half the people were diagnosed fewer than 13.6 years after the study started, and half were diagnosed more than 13.6 years after the study started.
Breast cancer was the most common cancer diagnosed in women, and prostate cancer was the most common cancer diagnosed in men. Of the people diagnosed with cancer:
34.5% of the women were diagnosed with breast cancer
39.6% of the men were diagnosed with prostate cancer
12% of the women and 13.7% of the men were diagnosed with lung cancer
10.2% of the women and 9.2% of the men were diagnosed with colorectal cancer
8% of the women and 7.7% of the men were diagnosed with blood or lymphatic cancer
7.9% of the women were diagnosed with cervical and endometrial cancer
3.4% of the women were diagnosed with ovarian cancer
3.1% of the women and 3.4% of the men were diagnosed with kidney cancer
2.5% of the women and 6.8% of the men were diagnosed with bladder cancer
2.5% of the women and 3.4% of the men were diagnosed with skin cancer (melanoma)
2.3% of the women and 2.9% of the men were diagnosed with pancreatic cancer
1.2% of the women and 1.5% of the men were diagnosed with stomach cancer
1% of the women and 0.4% of the men were diagnosed with thyroid cancer
During the follow-up period, there were 3,723 cardiovascular events among all the people in the study. These events included:
1,824 cases of coronary heart disease, also called coronary artery disease, which means the people had atherosclerosis
2,665 cases of heart failure
There are more than 3,723 cases of coronary heart disease, stroke, and heart failure because some people experienced more than one cardiovascular event at the same time, which the researchers counted as a single cardiovascular event in the complete total.
Among people who were not diagnosed with cancer, cardiovascular disease developed about 14 years after the study started.
Among people who were diagnosed with cancer, about half developed cardiovascular disease fewer than 5.2 years after being diagnosed with cancer, and half developed cardiovascular disease more than 5.2 years after being diagnosed with cancer. The time from cancer diagnosis to cardiovascular disease diagnosis was about:
6.2 years for people with breast cancer
6.3 years for people with prostate cancer
1.3 years for people with lung cancer
5.1 years for people with colorectal cancer
3.1 years for people with blood and lymphatic cancers
The researchers’ analysis showed that people who had been diagnosed with cancer had a 42% higher risk of developing cardiovascular disease than people who hadn’t been diagnosed with cancer. Specifically, cancer survivors were:
52% more likely to have heart failure
22% more likely to have a stroke
The researchers also looked at cardiovascular disease risk among people diagnosed with specific types of cancer:
People who had been diagnosed with breast, lung, colorectal, and blood and lymphatic cancers — but not prostate cancer — had a higher risk of having heart failure than people without cancer.
People who had been diagnosed with lung cancer had more than twice the risk of having a stroke than people with no history of cancer. Still, the researchers didn’t find a link between other cancers and a higher risk of having a stroke.
Only people who had been diagnosed with blood and lymphatic cancers had a higher risk of developing coronary heart disease than people with no history of cancer.
“Cardiovascular disease is one of the leading causes of death among some cancer survivors, and that risk is oftentimes neglected,” Roberta Florido, MD, MHS, assistant professor of medicine and director of cardio-oncology at Johns Hopkins University and first author of the study, said in a statement. “We hope our research increases awareness of heart disease risk in those who survive cancer and that healthcare providers actively reinforce the importance of prevention.”
What this means for you
Cardiovascular disease is a possible long-term side effect of certain breast cancer treatments. This study adds more evidence to the link between breast cancer treatment and heart problems.
But there is some good news: There are lifestyle changes you can make to help keep your risk of developing heart disease as low as it can be. A 2022 Dutch study found that exercise can help reduce the risk of heart problems in women with a history of breast cancer.
Exercise is so important that it’s now considered part of breast cancer care. The American Society of Clinical Oncology (ASCO) released guidelines on exercise, diet, and weight management during breast cancer treatment in May 2022. And in 2019, the American College of Sports Medicine updated its guidelines on exercise to ease a number of treatment side effects.
Other heart-healthy lifestyle changes recommended by the American Heart Association include:
eating a diet rich in nutrients and low in calories and avoiding foods with few nutrients and added sugar
never smoking or quitting if you do smoke
maintaining a healthy weight
being physically active every day, aiming for at least three 30-minute sessions of moderate-intensity aerobic exercise per week, plus two sessions of resistance exercise per week
limiting or avoiding alcohol
No matter how old you are, it’s never too late to get moving. Exercise can help you maintain a healthy weight, as well as ease stress.
Written by: Jamie DePolo, senior editor
— Last updated on July 17, 2022, 7:19 PM