- Design
- Systematic review and meta-analysis of cohort studies
- Population
- 536,399 CAYA cancer survivors and 1,810,572 cancer-free peers in 39 cohorts
- Primary outcome
- Incident cardiovascular disease
- Effect
- RR 1.99 (95% CI 1.66–2.40); childhood-diagnosed RR 2.48
This meta-analysis pooled 39 cohort studies comparing 536,399 survivors of childhood, adolescent and young adult cancer with 1.8 million people without cancer.
Survivors had about twice the risk of cardiovascular disease (RR 1.99, 95% CI 1.66–2.40), equating to about 90 extra events per 1,000 survivors. Risk was highest in those diagnosed as children (RR 2.48) compared with young adults (RR 1.61). The relative excess narrowed with longer follow-up but was still present beyond 20 years. Results held in sensitivity analyses restricted to high-quality and population-based studies.
The paediatrician and the GP are the clinicians most likely to see these patients after oncology follow-up ends. Blood pressure, lipids, weight and smoking deserve earlier and more regular attention in them than in their peers.
- Record a history of childhood cancer and its treatment in the problem list — it shapes cardiovascular risk for decades.
- Check blood pressure, lipids and weight regularly in childhood cancer survivors.
- Address smoking and activity early; survivors start from a higher baseline risk.
- Make sure survivors who received anthracyclines or chest radiotherapy know about recommended cardiac surveillance.
Why it matters
Cardiovascular disease is a leading late effect, and these patients often leave oncology follow-up without anyone owning that risk.
Don't overread it
The pooled cohorts are observational and differ in treatment era, so the excess cannot be attributed to any one therapy.
The statistics, in plain English
A risk ratio of 1.99 means about double the rate; the interval 1.66–2.40 is well clear of 1. The 90 excess events per 1,000 survivors converts that relative risk into an absolute one.
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