Associations of Changes in Metabolic Syndrome Status and Risk Factor Count With Incident Cardiovascular Events Among Cancer Survivors

Abstract

Objective: This study investigated the associations of changes in metabolic syndrome status and the number of metabolic syndrome risk factors after cancer diagnosis with the incidence of cardiovascular disease (CVD) events among cancer survivors. Methods: Using nationwide health screening data, we identified 344,681 individuals diagnosed with cancer at age ≥19 years from 2012 to 2017, who survived for at least 3 years without CVD events. Participants were classified according to their metabolic syndrome status and risk factor count both before and after cancer diagnosis. A CVD event was defined as a composite of myocardial infarction, stroke, or cardiovascular death. Results: During a median follow-up period of 5.0 years after surviving cancer for 3 years, 7,529 CVD events occurred. The cumulative incidence of CVD was highest among participants with persistent metabolic syndrome. Compared to participants consistently free of metabolic syndrome, the multivariable-adjusted hazard ratios (HRs) for CVD were 1.21 (95% confidence interval [CI], 1.13–1.30) for newly developed metabolic syndrome, 1.19 (95% CI, 1.10–1.27) for recovered metabolic syndrome, and 1.37 (95% CI, 1.30–1.45) for persistent metabolic syndrome. Participants who recovered from metabolic syndrome exhibited a lower risk compared to those with persistent metabolic syndrome (HR, 0.86; 95% CI, 0.80–0.93). Each +1 increase in risk factor count after cancer diagnosis was associated with increased CVD risk (HR, 1.09; 95% CI, 1.07–1.11). Conclusion: Changes in metabolic syndrome status and metabolic syndrome risk factor count after cancer diagnosis were significantly associated with CVD risk among cancer survivors. © 2026 The Korean Society of Lipid and Atherosclerosis.