Is the number of ideal cardiovascular health metrics in midlife associated with lower risk of cancer? Evidence from 3 European prospective cohorts

Thomas T van Sloten; Rachel E D Climie; Omar Deraz; Marie-Cécile Périer; Eugenie Valentin; Aurore Fayosse; Séverine Sabia; Elisabete Weiderpass; Xavier Jouven; Marcel Goldberg; Marie Zins; Mathilde Touvier; Mélanie Deschasaux-Tanguy; Léopold Fezeu; Serge Hercberg; Archana Singh-Manoux; Jean-Philippe Empana

doi:10.9778/cmajo.20220175

Is the number of ideal cardiovascular health metrics in midlife associated with lower risk of cancer? Evidence from 3 European prospective cohorts

CMAJ Open. 2023 Aug 22;11(4):E774-E781. doi: 10.9778/cmajo.20220175. Print 2023 Jul-Aug.

Authors

Thomas T van Sloten¹, Rachel E D Climie¹, Omar Deraz¹, Marie-Cécile Périer¹, Eugenie Valentin¹, Aurore Fayosse¹, Séverine Sabia¹, Elisabete Weiderpass¹, Xavier Jouven¹, Marcel Goldberg¹, Marie Zins¹, Mathilde Touvier¹, Mélanie Deschasaux-Tanguy¹, Léopold Fezeu¹, Serge Hercberg¹, Archana Singh-Manoux¹, Jean-Philippe Empana²

Affiliations

¹ Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France.
² Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France jean-philippe.empana@inserm.fr.

Abstract

Background: Primordial prevention may be a relevant strategy for the prevention of cancer. Given the commonality of risk factors and mechanisms between cancer and cardiovascular disease, we examined the associations between the number of ideal cardiovascular health metrics in midlife and incident cancer.

Methods: In 3 European cohorts (NutriNet-Santé and GAZEL, France; Whitehall II, United Kingdom), the number of ideal cardiovascular health metrics was determined at baseline (range 0-7). Follow-up for cancer events was until October 2020 (NutriNet-Santé), March 2017 (Whitehall II) and December 2015 (GAZEL). Cox regression was conducted in each cohort, and results were thereafter pooled using a random-effects model.

Results: Data were available on 39 718 participants. A total of 16 237 were from NutriNet-Santé (mean age 51.3 yr; 28% men), 9418 were from Whitehall II (mean age 44.8 yr; 68% men) and 14 063 were from GAZEL (mean age 45.2 yr; 75% men). The median follow-up was 8.1 years in NutriNet-Santé, 29.6 years in Whitehall II and 24.8 years in GAZEL, and yielded a total of 4889 cancer events. A greater number of ideal cardiovascular health metrics was associated with a lower overall cancer risk in each cohort, with an aggregate hazard ratio (HR) per 1 increment in number of ideal metrics of 0.91 (95% confidence interval [CI] 0.88-0.93). This association remained after removal of the smoking metric (aggregate HR per unit increment in number of ideal metrics: 0.94, 95% CI 0.90-0.97), and site-specific analysis demonstrated a significant association with lung cancer.

Interpretation: A greater number of ideal cardiovascular health metrics in midlife was associated with lower cancer risk, notably lung cancer. Primordial prevention of cardiovascular risk factors in midlife may be a complementary strategy to prevent the onset of cancer.

Abstract

Grants and funding