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Cardiovascular disease and cancer: shared risk factors and mechanisms

Nature Reviews Cardiology (2024)Cite this article

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Abstract

Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.

Key points

  • Cardiovascular disease (CVD) and cancer have a bidirectional relationship, with shared mechanisms and risk factors that predispose individuals to both disease states.

  • Shared modifiable risk factors for CVD and cancer include hypertension, diabetes mellitus, obesity, smoking, diet, physical activity and social determinants of health.

  • Patients with cancer are at increased risk of multiple CVD subtypes, as well as death from CVD, owing at least in part to the development of shared modifiable risk factors.

  • Patients with CVD are at increased risk of multiple cancer subtypes and cancer-related death, although variation exists among studies and among types of cancer.

  • Shared mechanisms underlying both CVD and cancer include chronic inflammation, oxidative stress, metabolic dysregulation, clonal haematopoiesis of indeterminate potential, microbial dysbiosis, hormonal effects and cell senescence.

  • Understanding the risk factors and mechanisms shared between CVD and cancer enables the prediction, prevention and treatment of both, which is necessary to advance the field of cardio-oncology.

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Fig. 1: The bidirectional relationship between CVD and cancer.
Fig. 2: Shared mechanisms of CVD and cancer.

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Acknowledgements

J.B.R. is supported by T32 CA009679. B.K. is supported by NIH R01 HL148272, R01 HL152707, R21 HL157886, K24HL167127, and American Heart Association Strategically Focused Research Network Award in Cardio-Oncology Disparities 849569, 869105, 994801, 994804.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Nicholas S. Wilcox, Kendyl Howell & Bonnie Ky

  2. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Uri Amit & Eva Berlin

  3. Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Uri Amit, Jacob B. Reibel, Eva Berlin & Bonnie Ky

  4. Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jacob B. Reibel

  5. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Bonnie Ky

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All the authors researched data for the article and discussed its content. N.S.W., U.A., J.B.R., E.B. and B.K. wrote the manuscript and reviewed/edited it before submission.

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Wilcox, N.S., Amit, U., Reibel, J.B. et al. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol (2024). https://doi.org/10.1038/s41569-024-01017-x

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