In a study reported in JACC: CardioOncology, Yaogang Wang, PhD, of the School of Public Health, Tianjin Medical University, China, and colleagues found that fulfillment of more components of a healthy lifestyle was associated with a reduced risk of developing cancer in a baseline cancer-free cohort and a reduced risk of cardiovascular disease (CVD) and type 2 diabetes in both the cancer-free cohort and a cohort of patients with cancer.¹

“A healthy lifestyle is associated with a slower transition from cancer development to the subsequent development of cardiovascular disease and type 2 diabetes.”

— Yaogang Wang, PhD, and colleagues

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Study Details

The study involved data from the UK Biobank on 397,136 individuals without cancer at recruitment and 35,564 patients with cancer (between the ages of 40 and 70) who were free of CVD and type 2 diabetes at recruitment. Lifestyle factors were assessed at baseline using a healthy lifestyle index using five cardiometabolic disease–related behaviors: smoking status, physical activity, diet, alcohol consumption, and sleep duration. For each healthy lifestyle factor, participants received a score of 1 if they met the criterion and 0 if they did not; the sum of the five components yielded a final score ranging from 0 to 5, with higher scores indicating a healthier lifestyle. Analyses were adjusted for age, sex, Townsend deprivation index, ethnicity, education level, employment status, hypertension, and body mass index.

Cancer, CVD, and Type 2 Diabetes Incidence

Maximum follow-up was 15 years. Among 397,136 cancer-free participants (mean age = 55.7 years, 44.6% were men), 40,097 (10.1%) developed cancer, 28,164 (7.1%) developed CVD, and 12,712 (3.2%) developed type 2 diabetes. Among 35,564 patients with prevalent cancer (mean age = 59.3 years, 33.0% were men), 2,902 (8.2%) developed CVD, and 1,284 (3.6%) developed type 2 diabetes.

Outcomes in Cancer-Free Cohort

Each 1-point increment in healthy lifestyle index score was associated with a reduced risk of developing cancer (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.91–0.93). Each 1-point increase was associated with a reduced risk of developing CVD after a cancer diagnosis among those with cancer (HR = 0.90, 95% CI = 0.86–0.94) and among those who remained free of cancer (HR = 0.88, 95% CI = 0.87–0.89) as well as a reduced risk of developing type 2 diabetes among those who developed cancer (HR = 0.84, 95% CI = 0.79–0.89) and among those remaining free of cancer (HR = 0.81, 95% CI = 0.80–0.83).

Outcomes in Cancer-Prevalent Cohort

Each 1-point increase in healthy lifestyle index score was associated with a reduced risk of development of CVD (HR = 0.90, 95% CI = 0.87–0.93) and type 2 diabetes (HR = 0.87, 95% CI = 0.83–0.91). Compared with healthy lifestyle index scores of 0 or 1, hazard ratios for development of CVD and development of type 2 diabetes were 0.72 (95% CI = 0.60–0.86) and 1.04 (95% CI = 0.80–1.34) for a score of 2; 0.64 (95% CI = 0.54–0.75) and 0.85 (95% CI = 0.66–1.10) for a score of 3; 0.61 (95% CI = 0.52–0.73) and 0.77 (95% CI = 0.59–0.83) for a score of 4; and 0.56 (95% CI = 0.46–0.67) and 0.62 (95% CI = 0.47–0.83) for a score of 5.

The benefit of higher healthy lifestyle index scores in reducing the risk for CVD was stronger in women vs men (P = .034 for interaction); hazard ratios for scores between 2 and 5 vs 0 or 1 ranged from 0.74 to 0.61 in men vs 0.59 to 0.37 in women. Higher healthy lifestyle index scores were associated with a lower risk for CVD and type 2 diabetes irrespective of age group.

The investigators concluded: “A healthy lifestyle is associated with a slower transition from cancer development to the subsequent development of CVD and type 2 diabetes. Moreover, among patients with cancer, a healthy lifestyle is associated with lower risk for CVD and type 2 diabetes. This study highlights the practical benefits of adherence to a healthy lifestyle.” 

DISCLOSURE: The study was supported by the National Natural Science Foundation of China. Dr. Wang and the otherstudy authors reported no conflicts of interest.

REFERENCE

1. Cao Z, Xu C, Yang H, et al: The role of healthy lifestyle in cancer incidence and temporal transitions to cardiometabolic disease. JACC: CardioOncol 3:663-674, 2021.