Frits I. Mulder, MD, Erzsébet Horváth-Puhó, PHD, Nick van Es, MD, et al
(Summary of the article)
This large population-based cohort study investigates the long-term risk of cardiovascular disease (CVD) among cancer survivors who previously received systemic cancer therapy but were cancer-free and off treatment for at least three years. Using comprehensive Danish national health registries, the study included 91,407 cancer survivors diagnosed between 2004 and 2019, each matched with five cancer-free individuals by birth year, sex, and calendar year, totaling 457,035 comparators. Participants were followed for up to five years to assess incidences of various cardiovascular and kidney diseases.
Key findings indicate that cancer survivors have elevated risks for certain cardiovascular conditions and kidney failure compared to the general population, though the degree of increased risk varies by cancer type and treatment received. Specifically, the study found a modestly increased risk of heart failure or cardiomyopathy (HR: 1.08), venous thromboembolism (HR: 1.50), pericarditis, endocarditis, or myocarditis (HR: 1.30), and kidney failure (HR: 1.17). Notably, there was no significant overall increase in ischemic heart disease, stroke, or atrial fibrillation among survivors compared to controls.
Risk patterns differed by cancer type and treatment agent. For example, venous thromboembolism risk was consistently higher across nearly all cancer types and treatment groups, while ischemic heart disease was increased only among lung cancer survivors. Heart failure risk was notably elevated for survivors of hematological malignancies and those treated with certain chemotherapy agents like anthracyclines and plant alkaloids. Platinum-based chemotherapy was associated with a slight increase in stroke risk, but other treatments were not. Hypertension risk was not elevated; in fact, some groups showed slightly lower rates than comparators.
The methodology emphasized rigorous matching and adjustment for multiple confounders, including prior comorbidities, cardiovascular risk factors, and medication use, to isolate the effects of systemic therapy. Data completeness and diagnostic accuracy in the Danish registries enhanced the study’s reliability.
The results highlight that while the absolute risks for some cardiovascular outcomes remain modest, certain subgroups—such as survivors treated with cardiotoxic agents—warrant particular attention. These findings support the need for long-term cardiovascular monitoring and proactive management of modifiable risk factors in selected cancer survivors, especially as cancer survivorship continues to rise globally.
The study addresses gaps left by prior research by ensuring that survivors were genuinely off active cancer treatment, reducing the chance that ongoing malignancy or therapy confounded risk estimates. It calls for heightened awareness among oncologists and cardiologists about late-onset cardiovascular sequelae of systemic cancer treatments.
In summary, this research underscores that although not all cancer survivors face uniformly higher cardiovascular risks, specific conditions—particularly thromboembolic events, heart failure, and myocarditis—are more common after systemic therapy. Personalized survivorship care plans, including cardiac risk assessment and tailored monitoring strategies, could mitigate these long-term health challenges, improving both lifespan and quality of life for cancer survivors.
J A C C : C A R D I O O N C O L O G Y , V O L . 7 , NO. 4 , 2 0 2 5 J U N E 2 0 2 5 : 3 6 0 – 3 7 8
