AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Incidence and Predictors of Short-Intermediate Term Cardiovascular Events After Contemporary Thoracic Radiation Therapy: Prospective Cohort of Lung and Esophageal Cancer
By Ebrahimi S, Palaskas NL, Pierce E et al.
Background: Although long-term radiation-induced cardiovascular (CV) disease is a recognized complication of thoracic radiotherapy (RT), recently, shorter and intermediate term CV events post thoracic RT have been observed. The incidence and risk factors driving these events need further investigation in contemporary, prospective cohorts receiving modern RT techniques including intensity-modulated RT (IMRT) versus proton beam therapy (PBT). Further, CV event prediction scores in the general population do not incorporate RT as a risk-enhancing factor. Research Question: To determine the incidence of short and intermediate-term CV events following curative-intent RT in patients with lung and esophageal cancer and to identify baseline clinical and treatment-related factors associated with CV risk. Methods: We assembled a prospective cohort of patients with locally advanced lung or esophageal cancer receiving curative-intent RT (IMRT or PBT) ± concurrent chemotherapy at a referral cancer center. At baseline, all patients underwent comprehensive CV risk assessment by clinical, lipid and diabetes assessment. Patients had longitudinal 3 monthly follow up for CV events, adjudicated by 2 cardiologists which included new onset arrhythmias, heart failure, pericardial disease, acute ACS, coronary revascularization or CVA. Results: Among 175 patients (68% lung, 32% esophageal cancer) with a median follow up of 23 months [9-34], 82 received PBT and 93 IMRT (Table). CV comorbidities included hypertension (56%), dyslipidemia (52%), and established ASCVD or high-risk ASCVD 10-year score. CV events occurred in 26% of patients, including most commonly, new arrhythmias in19%, with high frequency of events within year 1 after RT (cumulative incidence curves-Figure). On univariate Cox regression, age, dyslipidemia, pre-existing atrial fibrillation, and high-risk ASCVD 10-year score or established ASCVD were associated with higher risk of CV events. On multivariable analysis, dyslipidemia remained the only independent predictor of CV events (HR 2.08, 95% CI 1.06-4.05, p=0.033), adjusted for age and mean heart dose (Table). Radiation modality or mean heart dose were not independently associated with early to intermediate CV events risk post-RT. Conclusion: In this prospective cohort of thoracic cancer patients receiving contemporary RT, pre-existing dyslipidemia, potentially as a marker of high CV risk or established CV disease, was the only independent predictor of CV events, suggesting that baseline cardiovascular biology, more than RT modality or dose alone, drives early to intermediate post-RT CV morbidity. These findings highlight an actionable gap: comprehensive CV risk assessment, including lipid management, not routinely integrated into the thoracic cancer RT care, may be effective in identifying and mitigating risk of post-RT CV events.