Cardiovascular Risk Factors Are Associated With Future Cancer

Emily S. Lau, Samantha M. Paniagua, Elizabeth Liu, Manol Jovani, Shawn X. Li, Katherine Takvorian, Navin Suthahar, Susan Cheng, Greta L. Splansky, James L. Januzzi, Thomas J. Wang, Ramachandran S. Vasan, Bernard Kreger, Martin G. Larson, Daniel Levy, Rudolf A. de Boer, Jennifer E. Ho

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background: The extent to which co-occurrence of cardiovascular disease (CVD) and cancer is due to shared risk factors or other mechanisms is unknown. Objectives: This study investigated the association of standard CVD risk factors, CVD biomarkers, pre-existing CVD, and ideal cardiovascular (CV) health metrics with the development of future cancer. Methods: This study prospectively followed Framingham Heart Study and PREVEND (Prevention of Renal and Vascular End-Stage Disease) study participants free of cancer at baseline and ascertained histology-proven cancer. This study assessed the association of baseline CV risk factors, 10-year atherosclerotic (ASCVD) risk score, established CVD biomarkers, prevalent CVD, and the American Heart Association (AHA) Life's Simple 7 CV health score with incident cancer using multivariable Cox models. Analyses of interim CVD events with incident cancer used time-dependent covariates. Results: Among 20,305 participants (mean age 50 ± 14 years; 54% women), 2,548 incident cancer cases occurred over a median follow-up of 15.0 years (quartile 1 to 3: 13.3 to 15.0 years). Traditional CVD risk factors, including age, sex, and smoking status, were independently associated with cancer (p < 0.001 for all). Estimated 10-year ASCVD risk was also associated with future cancer (hazard ratio [HR]: 1.16 per 5% increase in risk; 95% confidence interval [CI] 1.14 to 1.17; p < 0.001). The study found that natriuretic peptides (tertile 3 vs. tertile 1; HR: 1.40; 95% CI: 1.03 to 1.91; p = 0.035) were associated with incident cancer but not high-sensitivity troponin (p = 0.47). Prevalent CVD and the development of interim CV events were not associated with higher risk of subsequent cancer. However, ideal CV health was associated with lower future cancer risk (HR: 0.95 per 1-point increase in the AHA health score; 95% CI: 0.92 to 0.99; p = 0.009). Conclusions: CVD risk, as captured by traditional CVD risk factors, 10-year ASCVD risk score, and natriuretic peptide concentrations are associated with increased risk of future cancer. Conversely, a heart healthy lifestyle is associated with a lower risk of future cancer. These data suggest that the association between CVD and future cancer is attributable to shared risk factors.

Original languageEnglish (US)
Pages (from-to)48-58
Number of pages11
JournalJACC: CardioOncology
Issue number1
StatePublished - Mar 2021


  • lifestyle risk factors
  • prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Oncology


Dive into the research topics of 'Cardiovascular Risk Factors Are Associated With Future Cancer'. Together they form a unique fingerprint.

Cite this