Document Type

Article

Publication Title

Cancers

Abstract

Background: Young patients with cancer may develop cardiovascular complications decades earlier than the general population, yet their long-term cardiovascular risk remains incompletely defined. Most prior evidence derives from older adults or therapy-specific analyses, leaving adolescents and young adults understudied as a distinct population. Methods: We performed a systematic review and meta-analysis of observational cohort, registry-based, and population-based studies evaluating cardiovascular outcomes or mortality among young patients with cancer (adolescents and young adults [15–39 years], <45 years, <50 years, or clearly defined young age subgroups) compared with age-matched comparators. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception through 26 February 2026. Two reviewers independently screened studies and assessed risk of bias using the Newcastle–Ottawa Scale. Evidence certainty was evaluated with GRADE. Random-effects models were used for pooled analyses. Results: Fifty-eight studies were included. Young patients with cancer had significantly increased risks of heart failure (HR, 4.08; 95% CI, 2.20–7.57), pulmonary embolism (HR, 4.63; 95% CI, 3.03–7.06), venous thrombosis (HR, 4.06; 95% CI, 2.51–6.58), and cardiomyopathy (HR, 3.52; 95% CI, 2.21–5.63). Cardiovascular mortality was also elevated (SMR, 4.30; 95% CI, 3.06–6.05), although a trim-and-fill analysis resulted in an adjusted pooled SMR of 1.79 (95% CI, 1.05–3.05, p = 0.0313). Overall cardiovascular disease risk was approximately 2-fold higher, with additional increases in stroke, arrhythmia, and hypertension. Heterogeneity was high for several key outcomes (I2, overall cardiovascular disease HR 96.0%; cardiovascular mortality SMR 99.1%; heart failure HR 92.5%; venous thrombosis HR 94.1%), and evidence certainty was low for most. Conclusions: Young patients with cancer face substantially increased risks of cardiovascular disease, particularly heart failure, cardiomyopathy, and thrombotic complications. Prospective studies are needed to determine whether earlier cardiovascular surveillance improves outcomes.

DOI

10.3390/cancers18213579

Publication Date

11-7-2026

Keywords

adolescent and young adult cancer, cardiovascular disease, cardiovascular mortality, cardio-oncology, survivorship, meta-analysis

ISSN

2072-6694

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