# Risk of incident cardiovascular disease events among older Asian, Native Hawaiian, and Pacific Islander colorectal cancer survivors in the United States: a cohort study

## TL;DR

This study examines cardiovascular disease risks among older Asian, Native Hawaiian, and Pacific Islander colorectal cancer survivors in the U.S., finding varied risks across different ethnic subgroups.

## Contribution

The study provides new insights into cardiovascular disease risk disparities among disaggregated Asian, Native Hawaiian, and Pacific Islander colorectal cancer survivors.

## Key findings

- East and Southeast Asian CRC survivors had lower CVD risk compared to non-Hispanic Whites after 1 year post-diagnosis.
- South Asian CRC survivors showed higher ischemic heart disease risk compared to East Asians.
- Disaggregated ANHPI groups exhibit heterogeneous CVD risk patterns, highlighting disparities.

## Abstract

Among Asian, Native Hawaiian, and Pacific Islanders (ANHPI) in the United States, cancer and cardiovascular disease are the leading causes of death. Colorectal cancer (CRC) is the third most common cancer among ANHPIs, with improving survival rates. However, the risk of cardiovascular disease (CVD) events among ANHPI CRC survivors is unknown, especially within disaggregated ANHPI race and ethnicity groups.

We estimated the risk of CVD events among ANHPI CRC survivors within the SEER-Medicare database. Composite CVD, heart failure, ischemic heart disease, and stroke/transient ischemic attack were identified using International Classification of Diseases (ICD) diagnostic codes. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CVD events among ANHPI regional subgroups.

Compared to non-Hispanic White (NHW) CRC survivors, the risk of composite CVD was lower among East and Southeast Asian CRC survivors at > 1 years after initial cancer diagnosis. The risk of composite CVD, heart failure, and ischemic heart disease were lower among East and Southeast Asians for follow-up > 5 years. When compared to East Asians, NHW and Southeast Asian CRC survivors had a higher risk of composite CVD, heart failure, and ischemic heart disease where South Asians had a higher risk of ischemic heart disease.

Within the disaggregated ANHPI race and ethnicity groups of CRC survivors, our results support heterogeneity of incident CVD events. Further research is needed to develop public health interventions to address the disparities in CVD risk, especially among the high-risk groups of South Asian and Southeast Asian CRC survivors.

The online version contains supplementary material available at 10.1186/s40959-025-00440-4.