Cancer survivorship is about more than preventing cancer recurrence. As people live longer after a cancer diagnosis, protecting cardiovascular and metabolic health becomes an increasingly important part of long-term survivorship. A major 2026 study in JAMA Cardiology provides a striking reminder of just how much chronic disease may be influenced by factors that can potentially be changed.
The study, “Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990–2023,” analyzed more than three decades of data from the Global Burden of Disease Study. The investigators examined 12 metabolic, behavioral, and environmental risk factors associated with ischemic heart disease (IHD), the leading cause of death in the United States.
Nearly 9 of 10 Heart Disease Deaths Were Linked to Modifiable Risks
The headline finding is remarkable: in 2023, an estimated 88.7% of U.S. ischemic heart disease deaths were attributable to modifiable risk factors. The leading contributors were:
- High systolic blood pressure: 47.2%
- Dietary risks: 38.6%
- High LDL cholesterol: 28.5%
- Other important contributors included high fasting glucose, obesity, kidney dysfunction, tobacco exposure, environmental exposures, and physical inactivity.
The percentages should not simply be added together because risk factors overlap and interact biologically.
There has been substantial progress. The age-standardized IHD mortality rate fell 58.7% between 1990 and 2023. Nevertheless, approximately 473,000 Americans died from IHD in 2023.
Even more concerning are two trends moving in the wrong direction: increasing body mass index and fasting plasma glucose. Increased exposure to high BMI was associated with a 54.5% increase in BMI-attributable IHD deaths compared with 1990, while increased exposure to high fasting glucose contributed to a 38.8% increase in glucose-attributable deaths.
Why This Matters to Cancer Patients and Survivors
This study was not conducted specifically in people with cancer, so its findings should not be directly extrapolated to cancer populations. But its message is highly relevant to Exercise Oncology.
Cancer survivors increasingly face competing long-term health risks. The cardiovascular risk factors emphasized in this study hypertension, excess body weight, abnormal glucose metabolism, unfavorable cholesterol levels, poor diet, smoking, and physical inactivity are precisely the types of health issues that comprehensive survivorship programs should recognize.
Importantly, the authors specifically identify lifestyle approaches involving improved nutrition, health education, and physical activity as components of multifaceted interventions addressing obesity.
This supports a broader concept that CancerFitness.org has repeatedly emphasized: exercise after cancer should not be viewed solely as a strategy for improving fitness.
Exercise can be part of comprehensive risk-factor management.
Exercise Oncology Should Look Beyond Cancer
An Exercise Oncology program should therefore consider more than aerobic capacity or muscular strength. Assessment and follow-up can help identify issues such as physical inactivity, declining functional capacity, excess adiposity, and loss of muscle mass, while the broader cancer-care team addresses blood pressure, glucose, lipids, nutrition, smoking, and other cardiovascular risks.
The study also demonstrates that risk modification can produce population-level results. Since 1990, changes in modifiable risk-factor exposure were estimated to have prevented approximately 180,000 IHD deaths, despite the counteracting effects of population growth and aging.
The lesson for cancer survivorship is compelling: living longer after cancer should also mean living healthier after cancer.
Exercise Oncology can help move survivorship care toward that goal by integrating appropriately prescribed physical activity with cardiovascular risk assessment, nutrition, weight and metabolic health management, smoking cessation, and medical treatment when indicated.
The CancerFitness.org Takeaway
The most important number in this publication may be 88.7%.
Nearly nine out of ten ischemic heart disease deaths were associated with potentially modifiable risks. For cancer survivors, many of whom may live for decades after diagnosis, this reinforces the importance of expanding our definition of successful cancer treatment.
The goal is not simply to survive cancer.
The goal is to help people remain active, functional, metabolically healthy, and cardio vascularly healthy throughout survivorship.
Call to Action: Make Cardiovascular Health Part of Cancer Survivorship
If you are undergoing cancer treatment or living beyond cancer, ask your cancer-care team about your physical activity, blood pressure, cholesterol, blood glucose, body composition, nutrition, and cardiovascular risk.
And ask one additional question:
“Can an individualized exercise program become part of my cancer care?”
At CancerFitness.org, we believe appropriately prescribed exercise should be considered an integral component of comprehensive cancer care not only to improve how patients feel and function, but also to help address the modifiable chronic-disease risks that can influence health for years after cancer treatment.
Reference: Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990-2023 A Systematic Analysis for the Global Burden of Disease Study 2023. Catherine P. Benziger, MD; Benjamin Stark, MA; Catherine O. Johnson, PhD; Gregory A. Roth, MD; and the GBD 2023 US IHD Collaborators. JAMA Cardiology September 2026 Volume 11, Number 9.
