Abstract 4366347: Temporal Shifts in Cardiovascular Death Among Patients with Cancer: 25-Year Analysis in the United States

Abstract

Background: Cardiovascular disease and cancer share overlapping risk factors, and as cancer survival improves, a growing population of survivors faces long-term cardiovascular risks. Despite this growing concern, trends in cardiovascular mortality among U.S. population suffering from cancer remain unclear. Hypothesis: We hypothesized that, after an initial decline, cardiovascular mortality among patients with cancer has increased in recent years reflecting the cumulative effects of treatment-related cardiotoxicity, aging survivorship, and emerging public health stressors such as obesity and COVID-19. Methods: We used data from the Centers for Disease Control and Prevention’s Multiple Cause of Death database (CDC WONDER) from 1999 to 2023. Mortality rates were extracted using ICD-10 codes: I00–I99 and C00–C97 for cardiovascular deaths and malignant neoplasms as underlying and contributing causes of death, respectively. Age-adjusted mortality rates (AAMRs) per 100,000 individuals aged ≥15 years were analyzed with Joinpoint regression. Annual percentage changes (APCs) and 95% confidence intervals (CIs) were calculated. Cancer incidence was obtained from U.S. Cancer Statistics from 1999 to 2021. Results: Among 16,002,473 cancer-related deaths, 688,810 (4.30%) occurred due to cardiovascular disease since 1999. AAMR declined from 16.30 to 14.70 by 2002 (APC: –3.49%, 95% CI: –5.76 to -1.17, P=0.006). From 2002 to 2012, it dropped significantly to 8.70 (APC: –5.34%, 95% CI: –5.93 to –4.74, p<0.001), followed by a slight non-significant decline to 7.80 in 2017 (APC: –1.84%, 95% CI: –3.72 to 0.07, p=0.058), then a significant rise to 9.0 by 2023 (APC: 3.01%, 95% CI: 2.00 to 4.05, p<0.001). After adjusting for cancer incidence, the cardiovascular death rate per 100,000 patients with cancer declined by 23.7%, from 2,676 in 1999 to 2,041 in 2005, and further decreased by 18.4% to 1,664 in 2008. This downward trend continued, reaching 1,365 in 2017 (a 21.9% decrease), but was followed by a 17.5% increase to 1,605 in 2021. Conclusion: Following a prolonged decline, cardiovascular mortality among patients with cancer has begun to rise. This resurgence highlights the urgent need for proactive cardiovascular risk assessment and targeted prevention strategies in cancer care and survivorship.