van Sloten Thomas T, Climie Rachel E D, Deraz Omar, Périer Marie-Cécile, Valentin Eugenie, Fayosse Aurore, Sabia Séverine, Weiderpass Elisabete, Jouven Xavier, Goldberg Marcel, Zins Marie, Touvier Mathilde, Deschasaux-Tanguy Mélanie, Fezeu Léopold, Hercberg Serge, Singh-Manoux Archana, Empana Jean-Philippe
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.
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
CMAJ Open. 2023 Aug 22;11(4):E774-E781. doi: 10.9778/cmajo.20220175. Print 2023 Jul-Aug.
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.
背景：一级预防可能是预防癌症的一项相关策略。鉴于癌症与心血管疾病在危险因素和机制上的共性，我们研究了中年时期理想心血管健康指标数量与癌症发病之间的关联。 方法：在3个欧洲队列研究（法国的NutriNet-Santé和GAZEL；英国的白厅II研究）中，在基线时确定理想心血管健康指标的数量（范围为0至7）。对癌症事件的随访截至2020年10月（NutriNet-Santé）、2017年3月（白厅II研究）和2015年12月（GAZEL）。在每个队列中进行Cox回归分析，之后使用随机效应模型汇总结果。 结果：共有39718名参与者的数据可供分析。其中16237名来自NutriNet-Santé（平均年龄51.3岁；男性占28%），9418名来自白厅II研究（平均年龄44.8岁；男性占68%），14063名来自GAZEL（平均年龄45.2岁；男性占75%）。NutriNet-Santé队列的中位随访时间为8.1年，白厅II研究为29.6年，GAZEL为24.8年，共发生4889例癌症事件。在每个队列中，理想心血管健康指标数量越多，总体癌症风险越低，理想指标数量每增加1个，综合风险比（HR）为0.91（95%置信区间[CI] 0.88 - 0.93）。去除吸烟指标后，这种关联依然存在（理想指标数量每增加1个单位的综合HR：0.94，95% CI 0.90 - 0.97），特定部位分析显示与肺癌存在显著关联。 解读：中年时期理想心血管健康指标数量越多，癌症风险越低，尤其是肺癌。中年时期对心血管危险因素进行一级预防可能是预防癌症发生的一项补充策略。
JAMA Psychiatry. 2023-4-1
JACC CardioOncol. 2021-3
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