Shared Risk Factors May Drive CVD Mortality in Patients With Early-Onset CRC: Meng-Han Tsai, PhD

A research letter published earlier this month in the Journal of the American Heart Association found that among 83,433 patients with early-onset colorectal cancer (CRC), defined as CRC diagnosed before age 50, men and racial and ethnic minority patients living in urban areas face a disproportionately elevated risk of cardiovascular disease (CVD) death.

Age-adjusted CVD mortality rates were nearly 5 times higher in men than women (94.9 vs 18.9 per 100,000 person-years), and American Indian/Alaska Native patients faced more than triple the CVD mortality risk of non-Hispanic White patients in urban settings. The findings challenge the conventional assumption that rural populations carry the greatest care disparities.

In a recent interview with The American Journal of Managed Care^®, Meng-Han Tsai, PhD, the study's lead investigator, said she was drawn to this topic through the lens of cardio-oncology, as the field recognizes that CVD and colorectal cancer share common risk factors, including diet, physical activity, and lifestyle behaviors. This overlap raised a key question for Tsai: could pre-existing cardiovascular risk in younger patients also shape their cancer outcomes?

To investigate, Tsai used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, conducting a secondary data analysis to identify patterns in CVD mortality among patients with early-onset CRC across sex, race, and geographic setting. Her goal was to understand who is most affected and where targeted interventions could reduce premature CVD deaths.

Tsai highlighted the most counterintuitive finding: patients in all-urban areas showed a higher CVD mortality risk than those in rural areas.

“That's kind of a little bit surprising to me, because usually we're thinking rural areas are probably impacted more because they lack access to specialty care and have transportation barriers,” she said.

Tsai speculated that urban health systems may be channeling resources toward older or more medically complex patients, potentially leaving younger patients with CRC underserved. However, she acknowledged the finding warrants further investigation.

“This part definitely needs more data to explore a little bit further,” she concluded. “Did the young population not have enough resources to get access to care?”

Reference

McCormick B. Younger male, minority patients with early-onset CRC in urban settings face higher cardiovascular death risk. AJMC^®. May 12, 2026. Accessed May 22, 2026. https://www.ajmc.com/view/younger-male-minority-patients-with-early-onset-crc-in-urban-settings-face-higher-cardiovascular-death-risk