In an analysis from the French GAZEL study reported in JACC: CardioOncology, Thomas Van Sloten, MD, PhD, of the Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris, and colleagues found that better cardiovascular health (CVH) scores at baseline and improvement in score over 7 years were associated with a reduced risk of incident cancers.1
As stated by the investigators: “The commonality of risk factors between cancer and cardiovascular disease suggests that primordial prevention (preventing the onset of risk factors) is a relevant strategy for cancer prevention.”
Thomas Van Sloten, MD, PhD
The GAZEL study is a prospective cohort study started in 1989 that aimed to address determinants of several chronic diseases in adults, with an emphasis on occupational factors. In the current analysis, associations between baseline scores on the American Heart Association (AHA) Life’s Simple 7 CVH scoring system in 1989/1990 and changes in scores 7 years later, in 1996/1997, and risk of incident cancers were examined, with follow-up through 2015. The AHA score ranges from 0 to 14, with a higher score indicating better CVH, with metrics consisting of smoking, physical activity, body mass index, diet, blood pressure, blood sugar, and cholesterol status. Scores of 0 to 7, 8 to 11, and 12 to 14 represent low, moderate, and high CVH scores, respectively.
Incident Cancers and Cardiac Events
The study population included 13,933 participants (mean age = 45.3 years, 24% women). After a median follow-up of 24.8 years (interquartile range = 19.4–24.9 years), incident cancer was diagnosed in 2,010 participants, and a cardiac event occurred in 899. Overall, 2,209 participants (15.8%) had poor, 11,046 (79.3%) had moderate, and 678 (4.9%) had high CVH scores. Incident cancers included 176 breast, 175 lung, 616 prostate, 115 colon, and 928 other cancers (most commonly, renal cancer in 58, bladder cancer in 55, rectal cancer in 43, pancreatic cancer in 35, lymphoid chronic leukemia in 30, thyroid cancer in 30, liver cancer in 28, and cancer of an unspecified site in 25). The mean patient age at cancer diagnosis was 61.3 years.
Risk According to Baseline AHA CVH Scores
For AHA CVH scores at baseline in 1989/1990, the risk of cancer (at any site) decreased by 9% (hazard ratio [HR] = 0.91, 95% CI = 0.88–0.93) per one-point increase in score. Each one-point increase was associated with a 20% (HR = 0.80, 95% CI = 0.77–0.83) reduction in risk for cardiac events. Significant reductions in incident cancer risk were observed for moderate and high CVH scores vs low CVH score. For individual cancers, hazard ratios per one-point increase in CVH score were 0.93 (95% CI = 0.84–1.02) for breast cancer, 0.69 (95% CI = 0.64–0.75) for lung cancer, 1.01 (95% CI = 0.96–1.06) for prostate cancer, 0.94 (95% CI = 0.84–1.05) for colon cancer, and 0.89 (95% CI = 0.86–0.92) for other cancers.
Risk According to Change in CVH Scores
A total of 9,958 participants had CVH scores available for 1996/1997. Of them, 8% had an improvement in CVH score category, 76% had no change, and 16% had a worse CVH category. Each one-point increase in CVH score between baseline and 1996/1997 was associated with a 5% decrease in the risk for incident cancer (HR = 0.95, 95% CI = 0.92–0.99) and a 7% reduction in the risk for cardiovascular events (HR = 0.93, 95% CI = 0.88–0.98). Compared with patients who changed from low CVH to low CVH score, significant reductions in risk for incident cancer were observed among patients changing from moderate to moderate score (HR = 0.75, 95% CI = 0.64–0.88), moderate to high score (HR = 0.62, 95% CI = 0.45–0.87), high to moderate/low score (HR = 0.64, 95% CI = 0.44–0.92), and high to high score (HR = 0.45, 95% CI = 0.27–0.77). For cancer types, changes in scores were associated with significant a reduction in risk for moderate to moderate (HR = 0.26, 95% CI = 0.16–0.43) and moderate to high (HR = 0.12, 95% CI = 0.02–0.86) for lung cancer and for moderate to moderate (HR = 0.71, 95% CI = 0.55–0.91), moderate to high (HR = 0.37, 95% CI 0.20–0.69), and high to moderate/low (HR = 0.52, 95% CI = 0.29–0.94) for “other” cancers.
Analysis With Omission of Smoking Metric From CVH Score
Analysis removing the smoking metric from the AHA CVH score showed that the association of higher CVH score at baseline or improvement in score at 1996/1997 with a risk of incident cancer remained significant. With exclusion of the smoking metric, a one-point increase in CVH score at baseline was associated with a hazard ratio of 0.94 (95% CI = 0.91–0.97), compared with 0.91 (95% CI = 0.88–0.93) with the smoking metric included. Similarly, a one-point increase in CVH score between baseline and 1996/1997 with exclusion of the smoking metric was associated with a hazard ratio of 0.95 (95% CI = 0.91–0.99), compared with 0.95 (95% CI = 0.92–0.99) with the inclusion of the smoking metric.
The investigators concluded: “Primordial prevention is a relevant strategy for the prevention of cancer in the population.”
DISCLOSURE: The study authors reported no conflicts of interest.
1. Van Sloten T, Valentin E, Climie RE, et al: Association of midlife cardiovascular health and subsequent change in cardiovascular health with incident cancer. JACC CardioOncol 5:39-52, 2023.