Cardiometabolic factors’ and cardiovascular risk in young adult cancer survivors: evidence from real-world data

Abstract Aims To assess the burden of cardiometabolic factors and their associations with cardiovascular disease (CVD) among young adult (YA) cancer survivors (diagnosed between ages 19 and 39 years), while exploring ethnic disparities. Methods and results We conducted a retrospective cohort study of 8943 YA cancer survivors diagnosed before 31 December 2021 with ≥2-year cancer survivorship using University of California, Irvine electronic medical records. Non-cancer participants were matched 1:1 based on sex and year of birth. The exposure status was defined by cardiometabolic factors including Type 2 diabetes (T2DM), hypertension, hyperlipidaemia, and obesity. Main outcomes were CVD outcomes encompassing stroke, myocardial infarction (MI), and congestive heart failure (CHF). Generalized linear mixed models with binary outcome were conducted to assess the associations of interest. The mean age at cancer diagnosis was 29.2 years (standard deviation: 5.90), with 57.39% female participants. Cardiometabolic factors were more prevalent in cancer survivors compared with non-cancer participants, with racial/ethnic disparities observed. Significant associations between cardiometabolic factors and CVD were identified after adjusting for potential confounders; cancer survivors with T2DM had higher odds of MI [odds ratio (OR): 6.99; 95% confidence interval (CI): 3.45–14.19] and CHF (OR: 12.304; 95% CI: 7.23–20.91). Hypertension was strongly associated with CHF (OR: 20.48; 95% CI: 11.79–35.57). Conclusion Cardiometabolic factors independently contribute to elevated CVD risk in YA cancer survivors, beyond the effects of cancer treatment alone. These findings underscore the need for integrated cardiometabolic risk assessment and prevention strategies in survivorship care, including early screening, lifestyle interventions, and targeted management approaches. Lay summary Why are young cancer survivors at higher risk of heart disease? Young adult cancer survivors (aged 19–39 years at diagnosis) may face a higher risk of developing cardiovascular diseases later in life, not only due to prior cancer treatment but also because of common, manageable health conditions such as diabetes and high blood pressure.Young adult cancer survivors had significantly higher rates of heart-related conditions, with those who had diabetes being nearly seven times more likely to experience a heart attack and over 12 times more likely to develop heart failure.These findings underscore the importance of follow-up care that includes early screening and management of cardiometabolic risk factors, not just cardiac monitoring to reduce long-term heart disease risk.