Title : Cardiovascular mortality in colon cancer a patient characteristics analysis: Population-based study
Abstract:
Background: Cardiovascular disease (CVD) has developed as a leading cause of non-cancer mortality among colorectal cancer survivors. Although advances in oncological therapy, the magnitude of specific cardiovascular mortality in colon cancer patients and its determinants throughout diverse demographic and clinical subgroups remain incompletely characterized at the population level.
Methods: A retrospective population-based cohort study using SEER 17 registries dataset (November 2024 submission; 2000-2022) was conducted. We included Adults aged ≥18 years with histologically confirmed primary colon cancer. The primary outcome was cardiovascular specific death (ICD-10 I00-I99). And the competing event is Cancer specific deaths were. Cause specific mortality was modelled using Cox proportional hazard regression. A novel CVD risk score of four variables was developed and internally validated using a 70/30 split sample approach.
Result: Among 535,189 patients (51.3% aged ≥70 years; 50.0% male), 53,428 (10.0%) died of CVD 80.7% from heart disease and 17.3% from stroke/cerebrovascular disease. Cumulative CVD incidence went 5.48% at five years and 13.21% at 15 years. Among 214,277 five years survivors, CVD surpassed cancer as the leading cause of late death (28.1% vs 17.8%). Multivariable Cox regression identified age ≥65 years (HR 3.81%, 95% CI 3.68-3.93), male sex (HR 1.30), widowhood (HR1.66), and regional stage (HR 1.17) as independent predicters of CVD mortality, while surgery (HR 0.56) and chemotherapy (HR 0.53) were inversely associated. The Colon-CVD Risk Score achieved a C-statistic of 0.643-0.646 across derivation and validation sets.
Conclusion: CVD is substantial competing cause of death in colon cancer patients and develops the dominant late cause of mortality among long term survivors. The colon-CVD Risk Score provides a simple, validated tool for cardiovascular risk stratification. These findings support systematic cardiovascular monitoring within oncological follow up pathways.
