Risk of cardiovascular disease among cancer survivors: systematic review and meta-analysis

Qian Li; Guofu Zhang; Xiating Li; Shangzhi Xu; Huafang Wang; Jun Deng; Zhipeng Cheng; Fengjuan Fan; Shi Chen; Meng Yang; Liang V Tang; Yu Hu

doi:10.1016/j.eclinm.2025.103274

Risk of cardiovascular disease among cancer survivors: systematic review and meta-analysis

EClinicalMedicine. 2025 Jun 5:84:103274. doi: 10.1016/j.eclinm.2025.103274. eCollection 2025 Jun.

Authors

Qian Li^{1

2}, Guofu Zhang³, Xiating Li⁴, Shangzhi Xu⁵, Huafang Wang^{1

2}, Jun Deng^{1

2}, Zhipeng Cheng^{1

2}, Fengjuan Fan^{1

2}, Shi Chen⁶, Meng Yang⁷, Liang V Tang^{1

2}, Yu Hu^{1

2}

Affiliations

¹ Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
² Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
³ School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China.
⁴ Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁵ Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China.
⁶ Department of Biobank, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁷ Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Abstract

Background: There have been conflicting studies on the associations between cancer and cardiovascular disease (CVD) risk. The hypothesis of this meta-analysis was to investigate whether cancer survivors had an increased risk of CVD compared to those without cancer based on population-based cohort studies.

Methods: We did a systematic review and meta-analysis of prospective and retrospective cohort studies. We searched PubMed, Embase, Web of Science, and Scopus published in any language from January 1, 1990 to February 24, 2025. We included cancer survivors and non-cancer controls. The primary outcome was the risk of CVD. The secondary outcomes included 17 CVD subtypes (e.g., ischemic heart, cerebrovascular, and peripheral vascular disease). Effect estimates (hazards ratios, HRs) with 95% CIs were pooled. Subgroup analyses, sensitivity analyses and meta-regression were performed to explore the stability of the results and the sources of heterogeneity. The protocol of this review was registered in PROSPERO: CRD42024559349.

Findings: A total of 160 population-based cohort studies involving 49,395,865 participants (9,092,869 cancer survivors vs. 40,302,996 non-cancer controls) were identified. Overall, the HR for CVD in cancer survivors was 1.47 [95% CI, 1.33-1.62] compared with that in non-cancer controls. Cancer increased the risk of all 17 CVD subtypes, with cancer having the greatest effect on venous embolism, thrombosis or thrombophlebitis (HR, 3.07 [2.03-4.65]) and the least on ischemic heart disease (HR, 1.13 [1.03-1.24]). The increased risk of CVD was consistently shown in cancer survivors of brain, hematological, respiratory, male genital, and breast cancers, whereas no significant higher CVD risk was observed for other cancer types. Elevated risk of CVD was consistently shown in subgroup analyses of study design, age at cancer diagnosis, sex, location, follow-up duration, control, disease diagnosis, and therapy. Male and younger cancer survivors had elevated risk of CVD than female and older cancer survivors.

Interpretation: This meta-analysis provides an up-to-date comprehensive global overview that cancer survivors had increased risk of CVD and 17 CVD subtypes than non-cancer controls. CVD risk evaluation and management need to be prioritized in cancer survivors, particularly among male, younger, and specific cancer survivors (brain, hematological, respiratory, male genital, and breast). This study provides supporting evidence that may inform future updates to guidelines for CVD prevention in cancer survivors, highlighting its public health relevance.

Funding: The National Key R&D Program of China, the National Natural Science Foundation of China and the Young Elite Scientists Sponsorship Program by CAST.

Keywords: Cancer; Cardiovascular disease; Cerebrovascular disease; Heart failure; Myocardial infarction.