Pre-existing cardiovascular disease at cancer diagnosis: national trends and future projections in england

Abstract

Cancer and cardiovascular disease (CVD) are the two leading causes of morbidity and mortality worldwide and frequently coexist due to shared risk factors and overlapping pathophysiology. Pre-existing CVD at cancer diagnosis complicates treatment decisions, limits tolerance to anticancer therapies, and is associated with poorer outcomes. However, national-level evidence describing how the burden of pre-existing CVD at cancer diagnosis has evolved over time, and how it may change in the future, remains limited. Understanding these trends is important for health service planning and integrated cardio-oncology care. To examine temporal trends in pre-existing CVD at cancer diagnosis from 2001 to 2020, assess the impact of common comorbidities and lifestyle risk factors, and project future CVD burden to 2050. We conducted a population-based serial cross-sectional study using linked UK electronic health records, including primary care, hospital admissions, cancer registry, and mortality data. Adults newly diagnosed with breast, prostate, lung, colorectal, or haematological cancer between 2001 and 2020 were included. Pre-existing CVD and subtypes were identified prior to cancer diagnosis. Annual crude and age-standardised prevalence estimates were calculated. Temporal trends were assessed using logistic regression adjusted for age, sex, and cancer site, with stratified analyses by cancer type, sex, ethnicity, and deprivation. Sequential models evaluated the association of cardiometabolic conditions, behavioural factors, and chronic systemic comorbidities. Projections to 2050 were generated using restricted cubic spline models to estimate CVD prevalence from 2021 to 2050. Among 773,590 patients with cancer, age-standardised prevalence of pre-existing CVD increased from 31.4% in 2001 to 39.2% in 2020. Lung and haematological cancers consistently showed the highest CVD burden, while breast cancer showed the lowest. The steepest increases were observed for heart failure, atrial fibrillation, and valvular heart disease, whereas myocardial infarction and stroke showed slower growth. Sequential modelling indicated that rising cardiometabolic and chronic systemic comorbidities were strongly associated with the observed temporal increase, while behavioural factors provided limited additional attenuation. Projections suggested that approximately half of patients may have pre-existing CVD at cancer diagnosis by 2050. The burden of pre-existing CVD at cancer diagnosis has increased substantially over the past two decades in the UK and is projected to rise further. These findings highlight the growing need for integrated prevention strategies and cardio-oncology services to address increasing multimorbidity in patients with cancer.