Association of Cardiovascular Health Metrics and Mortality Among Individuals With and Without Cancer

Although metrics of cardiovascular health have been associated with improved mortality, whether the association remains among individuals with a history of cancer has not been well characterized.

The National Health and Nutrition Examination Survey data from 2009 to 2018 were used to identify individuals with and without a history of cancer. For each participant, American Heart Association Life's Essential 8 cardiovascular health metrics of health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure) were obtained. All-cause, cardiovascular, and cancer-related mortality were noted. Out of 21 967 individuals, 8% had a history of cancer. In analyses adjusted for age, race and ethnicity, sex, and income among the whole cohort, better Life's Essential 8 cardiovascular health metrics were associated with lower all-cause (adjusted hazard ratio [aHR ], 0.38 [95% CI, 0.29-0.49]; P<0.001), cardiovascular (aHR, 0.38 [95% CI, 0.22-0.49]; P<0.001), and cancer mortality (aHR, 0.50 [95% CI, 0.31-0.79]; P=0.001). This association was driven by better health behaviors that were associated with lower all-cause (aHR, 0.30 [95% CI, 0.26-0.35]; P<0.001), cardiovascular (aHR, 0.39 [95% CI, 0.26-0.52]; P<0.001), and cancer mortality (aHR, 0.35 [95% CI, 0.26-0.47]; P<0.001), whereas better health factors were not associated with lower mortality. There were no significant interactions in these associations between individuals with and without cancer.

Better metrics of cardiovascular health, particularly health behaviors, are associated with improved all-cause, cardiovascular, and cancer mortality to a similar extent in individuals with and without cancer. Attempts to improve cardiovascular health should be prioritized similarly among individuals with and without cancer.