Purpose We sought to determine the long-term risk of
cardiovascular disease (CVD)-
stroke and
myocardial infarction-and
congestive heart failure (CHF) in older patients with
colorectal cancer, as well as to understand the roles that preexisting comorbidities and
cancer therapy play in increasing this risk. Patients and Methods We evaluated individuals from the SEER-Medicare database with incident stage I to III
colorectal cancer at age older than 65 years between January 1, 2000, and December 31, 2011 (n = 72,408) and compared these patients with a matched cohort of Medicare patients without
cancer (n = 72,408). Results Median age at diagnosis of
colorectal cancer was 78 years (range, 66 years to 106 years), and median follow-up was 8 years since diagnosis. The 10-year cumulative incidence of new-onset CVD and CHF were 57.4% and 54.5% compared with 22% and 18% for control, respectively ( P < .001). The interaction between
hypertension and
chemotherapy was significant ( P < .001) for CVD, and that between diabetes and
chemotherapy was significant ( P < .001) for CHF. Within the first 2 years since diagnosis, exposure to
capecitabine alone increased CHF hazard (hazard ratio [HR], 3.6; 95% CI, 12.76 to 4.38) compared with exposure to
fluorouracil alone. Conversely, patients who were treated with
fluorouracil alone had a higher CVD hazard at < 2 years and > 2 years since diagnosis compared with patients who received
capecitabine alone (< 2 years HR, 0.63; 95% CI, 0.53 to 0.75; > 2 years HR, 0.72; 95% CI, 0.62 to 0.84). Conclusion Older patients with
colorectal cancer are at increased risk of developing CVD and CHF. Diabetes and
hypertension interact with
chemotherapy to increase the risk of cardiovascular morbidity. Future studies should assess the potential for personalized therapeutic options for those with preexisting morbidities and for structured monitoring for patients with a history of exposure to
chemotherapy regimens, as well as explore the management of preexisting comorbidities to address long-term cardiovascular morbidity.