癌症患者发生动脉粥样硬化心血管疾病（ASCVD）的长期风险仍未完全定义。本研究旨在评估与非癌症人群相比，癌症患者的长期ASCVD风险。该研究是一项前瞻性的基于人群的研究，使用来自凯路远队列的数据，从2006年6月到2020年12月，匹配年龄（±1）和性别的1:1比例的非ASCVD的6204名新诊断癌症患者与非癌症对照组。进行多变量竞争风险分析，评估癌症诊断与发生ASCVD事件（包括心肌梗死、缺血性卒中、心力衰竭以及冠状动脉搭桥手术或经皮冠状动脉介入治疗）的风险关系。在中位随访5.3（1.7, 9.7）年期间，观察到1019例发生ASCVD事件。与无癌症的参与者相比，癌症患者在癌症诊断后的前几年内发生ASCVD事件的风险相似，并且随着时间的推移，风险下降。总体而言，长期来看，癌症患者发生ASCVD的风险较非癌症患者低，其复合ASCVD事件的风险比（95％置信区间）为0.52（0.45-0.60），缺血性卒中的风险比为0.43（0.35-0.53），心肌梗死的风险比为0.63（0.42-0.95），心力衰竭的风险比为0.63（0.48-0.83），冠状动脉再通术的风险比为0.82（0.60-1.11）。基线低密度脂蛋白胆固醇、空腹血糖、血压和高敏C反应蛋白水平可以独立预测该研究人群的ASCVD事件的发生。根据癌症类型进行亚组分析发现，在消化系统癌症或呼吸系统癌症患者中，ASCVD事件的风险明显降低，但对于泌尿生殖系统的癌症则未发现类似结果。多项敏感性分析的结果与主要分析相似。相较于非癌症个体，长期来看，癌症幸存者的ASCVD风险未增加，可能是由于癌症患者初始风险因素的有利特征所驱动。版权所有©2023 Elsevier Ltd.

The long-term risk of incident atherosclerotic cardiovascular diseases (ASCVD) among cancer patients remains incompletely defined. This study aimed to evaluate the long-term ASCVD risk in cancer patients compared with the non-cancer population.This was a prospective population-based study using data from the Kailuan cohort, 6,204 individuals with newly diagnosed cancer, free of ASCVD, were matched in a 1:1 ratio to non-cancer controls for age (±1) and sex, from June 2006 to December 2020. Multivariable competing risk analyses were performed to evaluate the association between cancer diagnosis and risk of incident ASCVD events (including myocardial infarction, ischemic stroke, heart failure, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention).During a median follow-up of 5.3 (1.7, 9.7) years, 1,019 incident ASCVD events were observed. Compared to participants without cancer, there was a similar risk for incident ASCVD events among cancer patients within the first few years after cancer diagnosis, and the risk declined over time. Overall, cancer patients showed lower risks of incident ASCVD compared to the non-cancer patients over the long term, with a hazard ratio (95% confidence interval) of 0.52 (0.45-0.60) for composite ASCVD events, 0.43 (0.35-0.53) for ischemic stroke, 0.63 (0.42-0.95) for myocardial infarction, 0.63 (0.48-0.83) for heart failure, and 0.82 (0.60-1.11) for coronary revascularization. Baseline level of low-density lipoprotein cholesterol, fasting blood glucose, blood pressure, and high-sensitivity C-reactive protein could independently predict the incident ASCVD among the study population. Subgroup analyses according to cancer types revealed a significantly lower risk of ASCVD events among patients with digestive cancer or respiratory cancer compared with non-cancer controls, but not for urologic or genital cancer. Multiple sensitivity analyses yielded similar results to the primary analysis.Long-term ASCVD risk among cancer survivors is not increased compared with the non-cancer individuals, probably driven by a favorable profile of baseline risk factor in cancer population.Copyright © 2023 Elsevier Ltd. All rights reserved.