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

BACKGROUND: Cancer survivors have nearly twice the risk of coronary heart disease (CHD) compared with the general population. OBJECTIVES: We examined whether joint risk factor control was associated with cancer-related excess CHD risk and residual life expectancy. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.