A large study led by researchers from Johns Hopkins Medicine showed that cancer survivors had a 42% greater risk of developing cardiovascular disease than people without cancer. This finding reinforces the importance of cardiovascular disease screening and prevention in cancer survivors.

The results of the study, which followed more than 12,000 adults for decades, showed that the risk of heart failure in cancer survivors was particularly high (52% higher risk), followed by stroke (22% higher risk). There were no significant differences in the risk of coronary heart disease between those with and without cancer.

The study also looked at specific cancer types and found that the risk of cardiovascular disease is not uniform across cancers. For example, breast, lung, colorectal, and hematological/lymphatic cancers were significantly associated with a higher risk of cardiovascular disease, whereas prostate cancer was not.

“Major advances in cancer treatment mean that patients are living longer and longer,” says Elizabeth Selvin, PhD, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and senior author of the study, which was published in the Journal of the American College of Cardiology. “This means we now need to pay attention to other chronic diseases, especially heart disease, in cancer survivors.”

The American Cancer Society estimates that there are more than 16.9 million adult survivors of cancer in the US today, and that the number will climb to over 22.1 million by 2030, putting increasing numbers at risk for cardiovascular disease.

Although the study was not designed to pinpoint the causes of increased cardiovascular disease risk among survivors of cancer, Roberta Florido, MD, assistant professor of medicine and director of cardio-oncology at Johns Hopkins University and first author of the study, says her team’s main hypothesis involves a combination of cancer- and noncancer-related factors.

Cardiac toxicity from cancer therapies, or negative cardiac effects of cancer therapies, may be particularly important in increasing the risk of cardiovascular disease in some survivors of cancer. For example, survivors of breast and blood cancers had significantly higher risk of cardiovascular disease, and these cancers are typically managed with a combination of chemotherapy and chest radiation that can damage the heart. Conversely, survivors of prostate cancer did not have an increased risk of cardiovascular disease. These patients can be managed with active surveillance or local therapies without the risk of cardiac toxicity.

“More research is needed to better understand why cancer survivors have a greater risk of cardiovascular disease and whether this is partly explained by the negative cardiac effects of some cancer therapies,” says Florido. “This could lead to more targeted preventive strategies for this population.”