Cardiovascular disease and cancer: shared risk factors and mechanisms

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.

Fig. 1 |. The bidirectional relationship between CVD and cancer.

Shared mechanisms and risk factors lead to a bidirectional relationship between cardiovascular disease (CVD) and cancer. As a result, CVD increases the risk of specific types of cancer as well as cancer-related mortality. Similarly, cancer increases the risk of diverse forms of CVD as well as CVD-related mortality. The list of example CVDs and cancers shown in the figure is not exhaustive.

Fig. 2 |. Shared mechanisms of CVD and cancer.

The underlying mechanisms shared by cardiovascular disease (CVD) and cancer arise from dysregulation of immune, genetic, metabolic, hormonal and microbial processes that ultimately regulate cellular ageing, proliferation, metabolism and injury. These mechanisms offer targets for therapies, both established and investigational, to prevent and mitigate both CVD and cancer.