Research Article| Volume 167, ISSUE 1, P51-57, October 2022

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Cardiovascular disease diagnoses among older women with endometrial cancer

Published:August 22, 2022DOI:


      • Women with endometrial cancer had a higher prevalence of CVD at their cancer diagnosis than matched women without cancer.
      • Incidence of new CVD diagnoses was also higher among endometrial cancer survivors than women without cancer.
      • Monitoring for CVD may be critical during endometrial cancer treatment and throughout long-term survivorship.



      Endometrial cancer (EC) shares risk factors (e.g. obesity) with cardiovascular disease (CVD), yet little research has investigated CVD diagnoses among EC survivors. We aimed to describe the burden of CVD diagnoses among older women with EC compared to women without a cancer history.


      Women aged 66+ years with an EC diagnosis during 2004–2017 (N = 44,386) and matched women without cancer (N = 221,219) were identified in the SEER-Medicare linked data. An index date was defined as the cancer diagnosis date of the EC case in that matched set. ICD-9/10 diagnosis codes were used to define CVD outcomes in the Medicare claims. Prevalent CVD was identified using diagnosis codes in the year before the index date. Hazard ratios (HRs) for incident CVD diagnoses after the index date were estimated using multivariable Cox proportional hazards regression. Women with a prevalent CVD were excluded from incidence analyses for that outcome.


      Compared to women without cancer, women with EC had a higher prevalence of CVD diagnoses at the index date. In analyses beginning follow-up at 1 year post-index date, EC survivors had an increased risk of incident CVD diagnoses including ischemic heart diseases (HR = 1.73; 95% CI: 1.69–1.78), pulmonary heart disease (HR = 1.95; 95% CI: 1.88–2.02), and diseases of the veins and lymphatics (HR = 2.71; 95% CI: 95% CI: 2.64–2.78). Risk of CVD diagnoses among women with EC was also elevated within the first year post-index date.


      Management of pre-existing CVD and monitoring for incident CVD may be critical during EC treatment and throughout long-term survivorship.
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        • American Cancer Society
        Cancer Facts & Figures 2022.
        American Cancer Society, Atlanta2022
        • Surveillance, Epidemiology, and End Results Program
        Cancer Stat Facts: Uterine Cancer.
        (Available from:) (Accessed April 10, 2019)
        • American Cancer Society
        Cancer Treatment & Survivorship Facts & Figures 2019–2021.
        American Cancer Society, Atlanta2019
        • Aune D.
        • Navarro Rosenblatt D.A.
        • Chan D.S.
        • Vingeliene S.
        • Abar L.
        • Vieira A.R.
        • Greenwood D.C.
        • Bandera E.V.
        • Norat T.
        Anthropometric factors and endometrial cancer risk: a systematic review and dose-response meta-analysis of prospective studies.
        Ann. Oncol. 2015; 26: 1635-1648
        • Powell-Wiley T.M.
        • Poirier P.
        • Burke L.E.
        • Després J.P.
        • Gordon-Larsen P.
        • Lavie C.J.
        • Lear S.A.
        • Ndumele C.E.
        • Neeland I.J.
        • Sanders P.
        • St-Onge M.P.
        Obesity and cardiovascular disease: a scientific statement from the American Heart Association.
        Circulation. 2021; 143: e984-e1010
        • Felix A.S.
        • Lehman A.
        • Foraker R.E.
        • Naughton M.J.
        • Bower J.K.
        • Kuller L.
        • Sarto G.E.
        • Stefanick M.L.
        • Van Horn L.
        • Jackson R.D.
        • Paskett E.D.
        Risk of cardiovascular disease among women with endometrial cancer compared to cancer-free women in the Women’s Health Initiative.
        Cancer Epidemiol. 2017; 51: 62-67
        • Soisson S.
        • Ganz P.A.
        • Gaffney D.
        • Rowe K.
        • Snyder J.
        • Wan Y.
        • Deshmukh V.
        • Newman M.
        • Fraser A.
        • Smith K.
        • Herget K.
        • Hanson H.A.
        • Wu Y.P.
        • Stanford J.
        • Al-Sarray A.
        • Werner T.L.
        • Setiawan V.W.
        • Hashibe M.
        Long-term cardiovascular outcomes among endometrial Cancer survivors in a large, population-based cohort study.
        J. Natl. Cancer Inst. 2018; 110: 1342-1351
        • National Cancer Institute. Surveillance, Epidemiology and End Results Program
        Overview of the SEER Program.
        (Available from:) (Accessed July 6, 2021)
        • National Cancer Institute. Division of Cancer Control & Population Sciences
        SEER-Medicare: About the Data Files.
        (Available from:) (Accessed Nov. 1, 2021)
        • National Cancer Institute. Division of Cancer Control & Population Sciences
        SEER-Medicare: How the SEER & Medicare Data are Linked.
        (Available from:) (Accessed Nov. 1, 2021)
        • Klabunde C.N.
        • Legler J.M.
        • Warren J.L.
        • Baldwin L.M.
        • Schrag D.
        A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients.
        Ann. Epidemiol. 2007; 17: 584-590
        • Klabunde C.N.
        • Potosky A.L.
        • Legler J.M.
        • Warren J.L.
        Development of a comorbidity index using physician claims data.
        J. Clin. Epidemiol. 2000; 53: 1258-1267
        • Anderson C.
        • Bae-Jump V.L.
        • Broaddus R.R.
        • Olshan A.F.
        • Nichols H.B.
        Long-term patterns of excess mortality among endometrial cancer survivors.
        Cancer Epidemiol. Biomark. Prev. 2021; 30: 1079-1088
        • Ward K.K.
        • Shah N.R.
        • Saenz C.C.
        • McHale M.T.
        • Alvarez E.A.
        • Plaxe S.C.
        Cardiovascular disease is the leading cause of death among endometrial cancer patients.
        Gynecol. Oncol. 2012; 126: 176-179
        • Felix A.S.
        • Blair C.K.
        • Lehman A.
        • Bower J.K.
        • Raman S.V.
        • Lazovich D.
        • Cohn D.E.
        • Prizment A.E.
        Cardiovascular disease mortality among women with endometrial cancer in the Iowa Women’s health study.
        Cancer Causes Control. 2017; 28: 1043-1051
        • Felix A.S.
        • Bower J.K.
        • Pfeiffer R.M.
        • Raman S.V.
        • Cohn D.E.
        • Sherman M.E.
        High cardiovascular disease mortality after endometrial cancer diagnosis: results from the Surveillance, epidemiology, and end results (SEER) database.
        Int. J. Cancer. 2017; 140: 555-564
        • Benjamin E.J.
        • Muntner P.
        • Alonso A.
        • Bittencourt M.S.
        • Callaway C.W.
        • Carson A.P.
        • Chamberlain A.M.
        • Chang A.R.
        • Cheng S.
        • Das S.R.
        • Delling F.N.
        • Djousse L.
        • Elkind M.S.V.
        • Ferguson J.F.
        • Fornage M.
        • Jordan L.C.
        • Khan S.S.
        • Kissela B.M.
        • Knutson K.L.
        • Kwan T.W.
        • Lackland D.T.
        • Lewis T.T.
        • Lichtman J.H.
        • Longenecker C.T.
        • Loop M.S.
        • Lutsey P.L.
        • Martin S.S.
        • Matsushita K.
        • Moran A.E.
        • Mussolino M.E.
        • O’Flaherty M.
        • Pandey A.
        • Perak A.M.
        • Rosamond W.D.
        • Roth G.A.
        • Sampson U.K.A.
        • Satou G.M.
        • Schroeder E.B.
        • Shah S.H.
        • Spartano N.L.
        • Stokes A.
        • Tirschwell D.L.
        • Tsao C.W.
        • Turakhia M.P.
        • VanWagner L.B.
        • Wilkins J.T.
        • Wong S.S.
        • Virani S.S.
        Heart disease and stroke statistics-2019 update: a report from the American Heart Association.
        Circulation. 2019; 139: e56-e528
        • Lloyd J.T.
        • Blackwell S.A.
        • Wei I.I.
        • Howell B.L.
        • Shrank W.H.
        Validity of a claims-based diagnosis of obesity among medicare beneficiaries.
        Eval. Health Prof. 2015; 38: 508-517
        • Suissa K.
        • Schneeweiss S.
        • Lin K.J.
        • Brill G.
        • Kim S.C.
        • Patorno E.
        Validation of obesity-related diagnosis codes in claims data.
        Diabetes Obes. Metab. 2021; 23: 2623-2631