People diagnosed with colorectal cancer are significantly more likely to die of cardiovascular causes than the general population, especially in the first two years after their cancer diagnosis and in people younger than 50 years, and patients diagnosed with human papillomavirus (HPV) have a significantly increased risk of heart disease and coronary artery disease (CAD), according to two different studies being presented at ACC.25.

Researchers used data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database to analyze outcomes among more than 630,000 U.S. adults diagnosed with colorectal cancer between 2000 and 2021. The study, the first to track rates of cardiovascular mortality and assess risk change over time, defined cardiovascular mortality as any deaths attributed to heart diseases, hypertension, strokes and other cerebrovascular diseases, atherosclerosis or a tear or aneurysm in the aorta.

Results from the study showed that people with colorectal cancer were overall 16% more likely to die of cardiovascular causes than people without colorectal cancer. The risk was highest in the first two years after a colorectal cancer diagnosis, with patients facing a 45% increased risk during this period. Among those who were younger than 50, the risk for cardiovascular mortality was 2.4-times higher for those with vs. without colorectal cancer. The increased risk was even higher in Black patients with colorectal cancer, who faced a 74% increased risk compared with the general population. Men had a 55% increased risk for cardiovascular mortality.

The authors note that the disparities observed in the study could stem from multiple factors, such as differences in socioeconomic status, geographic location or access to care, and warrant further study and attention. "Based on our findings, the two-year period after a colorectal cancer diagnosis is a critical period when patients need aggressive care to improve cardiovascular outcomes," says Ahsan Ayaz, MD, a member of the research team. "For example, there should be an aggressive approach to control cardiovascular risk factors and comorbidities like diabetes and hypertension. There is also a need for coordination between oncology teams and primary care teams, because most of those risk factors are managed by primary care providers."

In other research, the first to assess the association between HPV and heart disease, researchers conducted a meta-analysis consisting of seven studies conducted between 2011 and 2024 that include data on HPV status and cardiovascular outcomes among nearly 250,000 patients across a follow-up of three years to 17 years. Most were retrospective and longitudinal cohort studies; three were from the U.S., two from South Korea, one from Brazil and one from Australia.

Results showed that HPV-positive patients, compared with HPV-negative patients, had a 40% higher likelihood of developing cardiovascular disease and twice the risk of developing CAD compared with HPV-negative patients. The risk remained higher at 33% for HPV-positive patients, even after adjusting for sociodemographic factors, medical history, lifestyle behaviors, family history of heart disease and use of blood pressure-lowering drugs. No statistically significant association was found with high blood pressure.

"We always talk about cardiovascular risk factors like smoking, high blood pressure and so on, but we know that about 20% of cardiovascular disease cannot be explained by these conventional risk factors," said lead author Stephen Akinfenwa, MD. "This makes it important to identify non-conventional risk factors like HPV that could potentially be targeted."

Based on the findings, Akinfenwa said that clinicians could consider closer heart monitoring for people who test positive for HPV, in keeping with recommendations for patients with other known heart disease risk factors.

Further research is needed to better understand the strength and mechanisms of the linkage between HPV infection and heart disease and the potential role of HPV vaccination in preventing cardiovascular problems.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: ACC Annual Scientific Session, ACC25, Colorectal Neoplasms, Papillomavirus Infections, Coronary Artery Disease