Pre‐Existing and Post‐Cancer Major Cardiovascular Disease and Their Association With Mortality Outcomes Among Cancer Survivors in Australia
5 affiliations
- 1University of New South Wales (UNSW)
- 2University of Sydney
- 3Australian National University
- 4The University of Sydney and Cancer Council NSW
- 5Ingham Institute for Applied Medical Research
Abstract
Background As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population‐level evidence on the burden of pre‐existing and post‐cancer CVD remains limited. This study aims to quantify pre‐existing and post‐cancer newly documented major CVD and their association with mortality outcomes among people with cancer. Methods Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006 to 2016. The cohort was followed up until 31 December 2021. Fine‐Grey modelling estimated sub‐distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers. Results Overall, 18% (n = 62,675) of participants had pre‐existing CVD within 5 years before cancer diagnosis, varying by age (3% for age < 50 vs. 40% for ≥ 80). Of those without pre‐existing CVD (n = 281,661), 27% (n = 76,924) had post‐cancer newly documented CVD, with the highest age‐standardised incidence rates in pancreatic cancer (716 per 10,000 person‐years), followed by lung (657). The median follow‐up period was 6.8 years with an interquartile range: 2.1–10.3 The sHR of pre‐existing CVD for cancer mortality ranged from 0.99 (95% CI: 0.85–1.13) in cancer of kidney to 1.81 (95% CI = 1.71–1.91) in lymphoma, and for cardiovascular mortality, 1.98 (1.78–2.18) in lymphoma to 4.74 (4.39–5.09) in pancreatic cancer. The sHR of post‐cancer newly documented CVD for cancer mortality, ranging from 0.87 (95% CI: 0.69–1.05) in liver cancer to 2.33 (95% CI = 2.04–2.62) in cervical cancer and cardiovascular mortality, ranging from 1.45 (95% CI: 1.18–1.72) in myeloma to 3.39 (95% CI = 2.90–3.88) in liver cancer. Conclusion CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all‐cause mortality. Population‐based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.
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BibTeX
@article{rahman2026preexisting,
title = {{Pre‐Existing and Post‐Cancer Major Cardiovascular Disease and Their Association With Mortality Outcomes Among Cancer Survivors in Australia}},
author = {Md Mijanur Rahman and Katy Bell and Grace Joshy and Michael David and Karen Canfell and David Goldsbury and Bogda Koczwara and Emily Banks and Kazuaki Negishi and Geoff P. Delaney and Mei Ling Yap and Xue Qin Yu},
journal = {Cancer medicine},
year = {2026},
month = oct,
doi = {10.1002/cam4.72413},
url = {https://europepmc.org/article/PMC/PMC13691301},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pre‐Existing and Post‐Cancer Major Cardiovascular Disease and Their Association With Mortality Outcomes Among Cancer Survivors in Australia
AU - Md Mijanur Rahman
AU - Katy Bell
AU - Grace Joshy
AU - Michael David
AU - Karen Canfell
AU - David Goldsbury
AU - Bogda Koczwara
AU - Emily Banks
AU - Kazuaki Negishi
AU - Geoff P. Delaney
AU - Mei Ling Yap
AU - Xue Qin Yu
PY - 2026
DA - 2026/10/01
JO - Cancer medicine
DO - 10.1002/cam4.72413
UR - https://europepmc.org/article/PMC/PMC13691301
AB - Background As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population‐level evidence on the burden of pre‐existing and post‐cancer CVD remains limited. This study aims to quantify pre‐existing and post‐cancer newly documented major CVD and their association with mortality outcomes among people with cancer. Methods Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006 to 2016. The cohort was followed up until 31 December 2021. Fine‐Grey modelling estimated sub‐distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers. Results Overall, 18% (n = 62,675) of participants had pre‐existing CVD within 5 years before cancer diagnosis, varying by age (3% for age < 50 vs. 40% for ≥ 80). Of those without pre‐existing CVD (n = 281,661), 27% (n = 76,924) had post‐cancer newly documented CVD, with the highest age‐standardised incidence rates in pancreatic cancer (716 per 10,000 person‐years), followed by lung (657). The median follow‐up period was 6.8 years with an interquartile range: 2.1–10.3 The sHR of pre‐existing CVD for cancer mortality ranged from 0.99 (95% CI: 0.85–1.13) in cancer of kidney to 1.81 (95% CI = 1.71–1.91) in lymphoma, and for cardiovascular mortality, 1.98 (1.78–2.18) in lymphoma to 4.74 (4.39–5.09) in pancreatic cancer. The sHR of post‐cancer newly documented CVD for cancer mortality, ranging from 0.87 (95% CI: 0.69–1.05) in liver cancer to 2.33 (95% CI = 2.04–2.62) in cervical cancer and cardiovascular mortality, ranging from 1.45 (95% CI: 1.18–1.72) in myeloma to 3.39 (95% CI = 2.90–3.88) in liver cancer. Conclusion CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all‐cause mortality. Population‐based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.
SN - 2045-7634
ER -