Comprehensive Risk Factor Profiles, Coronary Heart Disease, and Life Expectancy in Cancer Survivors

Cancer survivors have nearly twice the risk of coronary heart disease (CHD) compared with the general population.

We examined whether joint risk factor control was associated with cancer-related excess CHD risk and residual life expectancy.

We analyzed 14,557 cancer survivors and 58,228 matched noncancer controls from the UK Biobank. Risk factor control was defined across 9 domains: blood pressure, body mass index, low-density lipoprotein cholesterol, hemoglobin A1c, renal function, smoking, physical activity, diet, and sleep. Cox proportional hazards models estimated associations with CHD, myocardial infarction (MI), and cardiovascular disease (CVD) mortality; flexible parametric survival models assessed life expectancy.

Over a median follow-up of 12.60 years, 1,298 CHD events, 348 MI events, and 211 CVD-related deaths occurred among cancer survivors. After adjustment for confounders, each additional controlled risk factor was associated with lower risks of CHD (HR: 0.85; 95% CI: 0.81-0.88), MI (HR: 0.81; 95% CI: 0.74-0.88), and CVD-related mortality (HR: 0.75; 95% CI: 0.67-0.84). Participants with ≥6 controlled risk factors had the lowest risks across cardiovascular outcomes. A higher degree of risk factor control was also associated with longer residual life expectancy at age 50 (33.83 vs 30.47 years in the ≥6 vs ≤ 3 controlled risk factor groups).

The joint risk factor control is associated with a lower risk of CHD, MI, and CVD-related mortality among cancer survivors. Comprehensive assessment and optimization of modifiable risk factors may be clinically relevant for cardiovascular risk management in cardio-oncology survivorship care.