Cardiovascular Risk After Cancer in Patients with Ischemic Heart or Peripheral Artery Disease

ObjectiveTo quantify 1-year risks of cardiovascular death, major adverse cardiovascular events (MACE), and venous thromboembolism (VTE) after cancer diagnosis in patients with pre-existing ischemic heart disease (IHD) or peripheral artery disease (PAD), and to identify clinical predictors of early vascular events in this high-risk population. Approach and ResultsUsing nationwide Danish registries, we identified 91,253 patients with IHD and/or PAD who developed a first primary cancer between 2002 and 2022. Competing-risk methods were used to estimate 1-year cumulative incidences of cardiovascular outcomes, and multivariable Cox models assessed associations with baseline clinical predictors. One-year cumulative incidences were 2.4 percent for cardiovascular death, 2.8 percent for MACE, and 1.8 percent for VTE, with substantial variation across cancer types. Neurologic, respiratory, and digestive cancers showed the highest vascular event rates. Prior stroke, myocardial infarction, and higher comorbidity burden were strong predictors of MACE, while previous VTE strongly predicted recurrent thrombosis. Statin therapy was associated with lower cardiovascular mortality (HR 0.66) and fewer MACE events (HR 0.84). ConclusionCancer diagnosis in patients with established atherosclerotic disease is followed by a substantial burden of early cardiovascular and thrombotic events. Distinct risk profiles across malignancy types and the protective association of statins highlight the relevance of vascular biology in shaping early outcomes and support continued use of guideline-directed preventive therapies during cancer care.