The burden of cardiovascular disease in lymphoma survivors: a population-based matched cohort study

Background — Cardiovascular disease (CVD) is a leading cause of morbidity in lymphoma survivors, yet contemporary data on CVD risk in survivors are limited.

Objectives — This study assessed the hazard and absolute incidence of CVD in lymphoma survivors relative to cancer-free controls and evaluated temporal risks changes.

Methods — We conducted a population-based matched cohort study of adults diagnosed with lymphoma in Ontario, Canada (2007-2018), matched 1:1 to cancer-free controls by age and sex. The primary outcome was CVD hospitalization, with follow-up through March 2024. Cause-specific hazard models accounted for death as a competing risk, and cumulative incidence functions assessed absolute risk. We tested the significance of an interaction term with calendar year to test for changes in CVD incidence between 2007 to 2010, 2011 to 2014, and 2015 to 2018.

Results — Among 36,334 lymphoma survivors (median age 65; 45% female), the average adjusted HR for CVD hospitalization was 1.58 (95% CI: 1.52-1.64) compared to cancer-free controls; this HR was comparable to cardiovascular risk factors such as hypertension. The HR was highest in the first-year post-diagnosis but remained elevated for at least 10 years. The absolute difference in CVD risk between lymphoma survivors and controls at 5 years doubled from 1.1% (95% CI: 0.3%-1.9%) in 2007-2010 to 2.3% (95% CI: 1.6%-3.0%) in 2015-2018 (P = 0.02).

Conclusions — Lymphoma survivors faced a persistently increased incidence of CVD compared to cancer-free individuals, and the absolute difference widened over the study period. The temporal risk patterns support current cardio-oncology guidelines recommending front-loaded and longitudinal cardiovascular surveillance.