Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, USA.
School of Medicine, New York Medical College, USA.
Eur J Prev Cardiol. 2021 Jul 10;28(7):715-721. doi: 10.1177/2047487320916595.
Cardiovascular disease and cancer share similar risk factors and are the leading causes of death worldwide. This study aimed to assess the association between cardiorespiratory fitness, cancer incidence and cancer mortality in men with cardiovascular disease.
Baseline cardiorespiratory fitness (treadmill exercise test) was assessed in 565 men aged 58.9 ± 17 with documented cardiovascular disease and free from any malignancy. Cox multivariable hazard models, population attributable fraction and exposure impact number were analyzed in model accounting for competing events for cancer outcomes.
Mean cardiorespiratory fitness was 7.6 ± 3.4 metabolic equivalents. During a 12.0 ± 7.5 year follow-up, 147 participants developed any type of cancer, 70 died from cancer, and five died from causes other than cancer as competing events. Compared to low cardiorespiratory fitness (<5 metabolic equivalents), moderate (5-10 metabolic equivalents) and high cardiorespiratory fitness (>10 metabolic equivalents) were associated with 50% (0.50, 95% confidence interval (0.27-0.91)) and 68% (0.32 (0.11-0.88)) reduced risks for cancer mortality (p trend = 0.026), respectively. Survival time was longer among individuals with moderate (20.8 (19.7-22) years) and high (24.9 (23-26.7) years) compared to low cardiorespiratory fitness (17.2 (15.1-19.3) years), p < 0.001. Population attributable fraction and exposure impact number for cancer mortality were 13% (4.1-17.7) and 10.8 (5.1-56.4), p = 0.01, respectively. Cardiorespiratory fitness was not associated with cancer incidence.
Higher cardiorespiratory fitness was independently associated with lower risk of cancer mortality and extended survival time in men with cardiovascular disease, although it was not associated with cancer incidence. Improving cardiorespiratory fitness through supervised exercise rehabilitation programs could potentially serve as a cost-effective public-health strategy for secondary prevention and survivorship in men with cardiovascular disease.
心血管疾病和癌症具有相似的危险因素，是全球范围内导致死亡的主要原因。本研究旨在评估心血管疾病男性的心肺适能与癌症发病率和癌症死亡率之间的关系。
对 565 名年龄为 58.9±17 岁、有记录的心血管疾病且无任何恶性肿瘤的男性进行基线心肺适能（跑步机运动试验）评估。在考虑竞争事件的癌症结局的模型中，分析 Cox 多变量风险模型、人群归因分数和暴露影响数量。
平均心肺适能为 7.6±3.4 代谢当量。在 12.0±7.5 年的随访期间，147 名参与者患上了任何类型的癌症，70 人死于癌症，5 人死于竞争事件（非癌症原因）。与低心肺适能（<5 代谢当量）相比，中（5-10 代谢当量）和高心肺适能（>10 代谢当量）与癌症死亡率降低 50%（0.50，95%置信区间（0.27-0.91））和 68%（0.32（0.11-0.88））相关（p 趋势=0.026）。与低心肺适能者相比，中（20.8（19.7-22）年）和高（24.9（23-26.7）年）心肺适能者的生存时间更长，p<0.001。癌症死亡率的人群归因分数和暴露影响数分别为 13%（4.1-17.7）和 10.8（5.1-56.4），p=0.01。心肺适能与癌症发病率无关。
在患有心血管疾病的男性中，更高的心肺适能与癌症死亡率风险降低和生存时间延长独立相关，尽管与癌症发病率无关。通过监督锻炼康复计划提高心肺适能可能成为心血管疾病男性二级预防和生存的一种具有成本效益的公共卫生策略。
