Hematologic Cancer Survivors Face Elevated Cardiovascular Risk, Yet Cardiac Screening Remains Low
Hematologic cancer survivors face elevated CVD risk and fourfold higher heart failure risk. Cardiac screening is low among cardiotoxic treatment recipients. A trial found simple risk assessment may suffice.
Survivors of hematologic cancers face a substantially elevated risk of developing cardiovascular disease (CVD), according to a meta-analysis published online June 22 in BMC Cancer. Based on 50 studies with 550,385 participants, the pooled fully adjusted relative risk for total CVD associated with leukemia was 2.68, with relative risks of 1.46 for ischemic heart disease, 4.13 for heart failure, and 3.05 for stroke. For Hodgkin lymphoma and non-Hodgkin lymphoma survivors, similar positive associations were observed. Compared with survivors who underwent chemotherapy (relative risk, 2.12), radiotherapy-treated survivors had a greater risk of CVD (relative risk, 4.06).
A population-based Danish cohort study discussed at a JACC: CardioOncology Journal Club webinar evaluated long-term risks of heart failure, venous thromboembolism, kidney failure, and inflammatory cardiac conditions in cancer survivors who were alive, cancer-free, and off treatment three years after diagnosis. The findings highlighted that cardiovascular risk varies by cancer type and prior treatment exposure, including elevated heart failure risk among survivors of hematologic malignancies and those previously treated with established cardiotoxic therapies.
Despite these risks, cardiac screening among patients receiving cardiotoxic cancer therapy remains limited. In a study published in The American Journal of Cardiology, only 37% of patients with cancer exposed to potentially cardiotoxic treatments received baseline cardiac screening, and less than 1% received routine cardiac monitoring within one year following treatment initiation. The retrospective cohort study used SEER-Medicare data and included 2,143 female Medicare patients with cancer aged at least 66 years who received immune checkpoint inhibitors, anti-HER2 agents, or anthracycline from January 2014 through December 2018. Baseline cardiac screening was received by 11% of patients treated with immune checkpoint inhibitors, 58% of those treated with anthracyclines, and 54% of patients treated with anti-HER2 agents. Provider-level factors accounted for 12% of the variation in baseline cardiac screening, while hospital-level factors accounted for 3%. Individuals with a history of alcohol use had lower baseline cardiac screening rates, and those characterized as high- or very-high-risk were more likely to receive baseline screening.
A randomized clinical trial published in JAMA Network Open found that adult survivors of childhood cancer did not get added benefit from tailored counseling beyond what was achieved with standard cardiovascular risk assessments. The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) Study, part of the Childhood Cancer Survivor Study, enrolled 347 adult survivors of childhood cancer (mean age 40.5 years; 52.4% male) across nine US metropolitan areas between 2017 and 2020; all had been exposed to cardiotoxic cancer therapies as children. At baseline, 53.0% had undertreated hypertension, 51.9% had undertreated dyslipidemia, and 49.0% had undertreated glucose intolerance. By one year, 26% of individuals in the intervention group and 30.2% of enhanced-care controls had less undertreatment for hypertension, dyslipidemia, and glucose intolerance, a nonsignificant between-group difference. The intervention group had a significant reduction in systolic blood pressure (-4.6 mm Hg; 95% CI -7.1 to -2.1 mm Hg), and the controls had a significant reduction in triglycerides (-48.9 mg/dL; 95% CI -91.9 to -5.8 mg/dL). Greater engagement with counseling sessions and action plans was tied to less undertreatment at one year (OR 0.31; 95% CI 0.18-0.72).
Approximately 500,000 survivors of childhood cancer live in the United States. By age 50, around 10% of those exposed to cardiotoxic treatments such as anthracyclines or chest radiotherapy will develop ischemic heart disease and/or heart failure. The American Heart Association released a scientific statement in 2025 exploring cardiovascular toxicity in patients treated for childhood cancer.