Prior Cervical HSIL Linked to Higher Cardiovascular Risk and Mortality in Young Women: Research Shows
Sweden: A nationwide study found that adolescents and young adults with a history of cervical high-grade squamous intraepithelial lesion (HSIL) have a significantly increased risk of cardiovascular disease and higher mortality compared with matched controls. These findings highlight the need for further research and highlight the importance of increased clinical vigilance for cardiovascular risk assessment and preventive strategies in women with prior HSIL.
The research, published as a Research Letter in JAMA Oncology, was led by Jakob Hytting from the Department of Cardiology, Norrköping, Linköping University, Sweden, and colleagues. While cancer and cardiovascular disease (CVD) are increasingly recognized as interconnected conditions, young women with cervical HSIL have rarely been included in cardiovascular outcome studies. HSIL, commonly linked to human papillomavirus (HPV) infection, may promote systemic inflammation and vascular dysfunction—mechanisms that could accelerate atherosclerosis and elevate long-term cardiovascular risk.
To explore this association, investigators used data from the Rebuc study database, incorporating information from the Swedish National Cancer Register between 1958 and 2021. The cohort included females aged 15 to 24 years diagnosed with cervical HSIL, defined as moderate to severe dysplasia or carcinoma in situ (cervical intraepithelial neoplasia grades 2–3). Each case was matched with five controls by age, sex, and residence. Data were linked across multiple national health and population registries to assess cardiovascular outcomes and mortality.
Key Findings:
- The study included 29,960 young women with prior HSIL (median age 23 years) and 149,606 matched controls.
- Women with prior HSIL had a 20% higher overall risk of developing cardiovascular disease (HR, 1.20).
- The risk was significantly higher for myocardial infarction (HR, 1.58).
- Heart failure risk was also elevated (HR, 1.38).
- Cerebrovascular disease risk was increased (HR, 1.42).
- A maternal or paternal history of cardiovascular disease further increased cardiovascular risk.
- During follow-up, 3.1% of women with prior HSIL died compared with 2.1% of controls.
- All-cause mortality was higher among women with prior HSIL (HR, 1.52).
- Cardiovascular mortality was also significantly elevated (HR, 1.49).
- Myocardial infarction and sudden cardiac death were the leading causes of death.
- Acute respiratory distress and strangulation were additional notable causes of death.
- Cancer-related mortality was infrequent but higher in women with prior HSIL (HR, 2.24).
- The most common cancers diagnosed after five years were skin, breast, and lung cancers.
- Gastrointestinal cancers were the main cause of cancer-related deaths in both groups.
The authors noted that lifestyle factors often associated with HPV infection—such as smoking and obesity—may contribute to cardiovascular risk. Additionally, surveillance bias cannot be ruled out, given that women with HSIL may have more frequent healthcare contact. As a registry-based study, the findings are also subject to potential confounding and measurement limitations.
Despite these constraints, the results suggest that cervical HSIL in adolescence and early adulthood may signal heightened long-term cardiovascular vulnerability. The authors call for further studies to clarify underlying mechanisms and to determine whether targeted prevention strategies could mitigate excess cardiovascular risk in this population.
Reference:
Hytting J, Södling J, Hytting A, et al. Cardiovascular Events in Women With Prior Cervical High-Grade Squamous Intraepithelial Lesion. JAMA Oncol. Published online February 19, 2026. doi:10.1001/jamaoncol.2025.6504
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