In an analysis from the French GAZEL study reported in JACC: CardioOncology, Van Sloten et al found that better cardiovascular health scores at baseline and improvement in scores over 7 years were associated with a reduced risk of incident cancers.

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.”

Study Details

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 cardiovascular health 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 higher score indicating better cardiovascular health, 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 cardiovascular health 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 cardiovascular health 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 age at cancer diagnosis was 61.3 years.

Risk According to Baseline AHA Cardiovascular Health Scores

For AHA cardiovascular health scores at baseline in 1989/1990, the risk of cancer (at any site) decreased by 9% (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.88–0.93) per 1-point increase in score. Each 1-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 cardiovascular health scores vs low cardiovascular health scores. For individual cancers, hazard ratios per 1-point increase in cardiovascular health 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 Cardiovascular Health Scores

A total of 9,958 participants had cardiovascular health scores available for 1996/1997. Of these, 8% had an improvement in cardiovascular health score category, 76% had no change, and 16% had a worse cardiovascular health category. Each 1-point increase in cardiovascular health score between baseline and 1996/1997 was associated with a 5% decrease in risk for incident cancer (HR = 0.95, 95% CI = 0.92–0.99) and a 7% reduction in risk for cardiovascular events (HR = 0.93, 95% CI = 0.88–0.98).

Compared with patients who changed from low cardiovascular health to low cardiovascular health 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 (HR = 0.62, 95% CI = 0.45–0.87), high to moderate/low (HR = 0.64, 95% CI = 0.44–0.92), and high to high (HR = 0.45, 95% CI = 0.27–0.77). For cancer types, changes in scores were associate with significant 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 Cardiovascular Health Score

Analysis removing the smoking metric from the AHA cardiovascular health score showed that the association of higher cardiovascular health score at baseline or improvement in score at 1996/1997 with risk of incident cancer remained significant. With exclusion of the smoking metric, a 1-point increase in cardiovascular health 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 1-point increase in cardiovascular health 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 inclusion of the smoking metric.

The investigators concluded, “Primordial prevention is a relevant strategy for the prevention of cancer in the population.”

Jean-Philippe Empana, MD, PhD, of INSERM U970, Paris Cardiovascular Research Centre, Paris Descartes University, is the corresponding author for the JACC: CardioOncology article.

Disclosure: For full disclosures of the study authors, visit jacc.org.