Medical College of Georgia at Augusta University Augusta GA USA.
Emory University Atlanta GA USA.
J Am Heart Assoc. 2024 Sep 3;13(17):e034438. doi: 10.1161/JAHA.124.034438. Epub 2024 Aug 27.
Cardiovascular disease (CVD) and cancer frequently co-occur due to shared risk factors such as obesity, which is linked to CVD and 14 cancer types. This study explores whether CVD pathophysiologies, combined with obesity, increase cancer risk, impacting clinical management.
Data from the ARIC (Atherosclerosis Risk in Communities) study, spanning 28 years, were analyzed. The cohort included 5127 participants with incident CVD (myocardial infarction, stroke, heart failure, coronary heart disease), of whom 1511 developed a first primary cancer. Follow-up began at CVD diagnosis after Visit 1. Obesity was assessed using body mass index, waist circumference, and waist-to-hip ratio. Incidence rate differences between obesity groups were adjusted for age, sex, and center, whereas the obesity-cancer association was estimated using Fine-Gray regression adjusted for shared risk factors including smoking. Cancer incidence in obese individuals with CVD (body mass index: rate differences=226.6/100 000 person-years) was higher than in those with normal weight. Although obesity was not linked to overall cancer after adjusting for shared risk factors, it was nominally associated with obesity-related cancers. Specifically, women with CVD and obesity had increased obesity-related cancer risk (body mass index: hazard ratio, 1.67 [95% CI, 1.17-2.31]). No significant associations were found in men, even after excluding prostate cancer.
This study suggests that obesity is linked to higher obesity-related cancer risk in women with incident CVD, independent of shared risk factors. Further research is needed to eliminate residual confounding, understand sex differences, and explore how CVD pathophysiologies and obesity together influence cancer risk.
心血管疾病 (CVD) 和癌症常因肥胖等共同风险因素而同时发生，肥胖与 CVD 和 14 种癌症类型有关。本研究探讨 CVD 病理生理学与肥胖相结合是否会增加癌症风险，从而影响临床管理。
对 ARIC（社区动脉粥样硬化风险）研究的数据进行了分析，该研究跨度 28 年，共纳入 5127 名患有 CVD（心肌梗死、中风、心力衰竭、冠心病）的患者，其中 1511 人首次确诊为癌症。随访始于第 1 次就诊后 CVD 诊断。肥胖使用体重指数、腰围和腰臀比进行评估。对年龄、性别和中心进行调整后，计算肥胖组之间的发病率差异，而使用 Fine-Gray 回归估计肥胖与癌症的相关性，该回归调整了包括吸烟在内的共同风险因素。患有 CVD 的肥胖个体（体重指数：差异率=226.6/100000 人年）的癌症发病率高于体重正常者。尽管在调整了共同风险因素后，肥胖与总体癌症无关，但与肥胖相关的癌症有一定的关联。具体而言，患有 CVD 和肥胖的女性肥胖相关癌症风险增加（体重指数：风险比，1.67[95%CI，1.17-2.31]）。在男性中未发现显著相关性，即使排除前列腺癌后也是如此。
本研究表明，对于患有 CVD 的女性，肥胖与更高的肥胖相关癌症风险相关，这与共同风险因素无关。需要进一步研究以消除残余混杂因素，了解性别差异，并探讨 CVD 病理生理学和肥胖如何共同影响癌症风险。
