Incidence of and mortality risk from cardiovascular diseases after a cancer diagnosis: An umbrella review

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors, driven by the cancer itself, its treatments, and shared risk factors. Despite numerous systematic reviews and meta-analyses, the evidence remains fragmented and inconsistent, limiting its clinical utility. This umbrella review synthesised evidence on the incidence of CVD and CVD-related mortality after a cancer diagnosis and critically appraised the methodological quality of the literature. A comprehensive search of PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library from inception to February 2025 identified 34 eligible reviews from 12,942 records. Cancer patients consistently showed higher risks of CVD (relative risks, 1.11–2.32) and CVD-related mortality (hazard ratios, 1.09–1.70) compared with cancer-free populations, with variation by cancer type and CVD subtype. Reported outcomes included stroke, atrial fibrillation, and thromboembolic events, with evidence also indicating that patients with pre-existing CVD may develop additional cardiovascular events after cancer diagnosis. The methodological quality of included reviews ranged from critically low to moderately high, with none rated as high quality. These findings confirm a substantial cardiovascular burden among cancer patients while highlighting important limitations in the evidence base. Strengthening integrated cardio-oncology care and prioritising high-quality research are essential to improve risk stratification and patient outcomes.