Association of Cardiometabolic Disease With Cancer in the Community

Elizabeth E Liu; Navin Suthahar; Samantha M Paniagua; Dongyu Wang; Emily S Lau; Shawn X Li; Manol Jovani; Katherine S Takvorian; Bernard E Kreger; Emelia J Benjamin; Wouter C Meijers; Stephan J L Bakker; Lyanne M Kieneker; Eke G Gruppen; Bert van der Vegt; Geertruida H de Bock; Ron T Gansevoort; Shehnaz K Hussain; Udo Hoffmann; Greta Lee Splansky; Ramachandran S Vasan; Martin G Larson; Daniel Levy; Susan Cheng; Rudolf A de Boer; Jennifer E Ho

doi:10.1016/j.jaccao.2022.01.095

Association of Cardiometabolic Disease With Cancer in the Community

JACC CardioOncol. 2022 Mar 15;4(1):69-81. doi: 10.1016/j.jaccao.2022.01.095. eCollection 2022 Mar.

Authors

Elizabeth E Liu¹, Navin Suthahar², Samantha M Paniagua³, Dongyu Wang¹, Emily S Lau^{4

5

6}, Shawn X Li⁶, Manol Jovani^{7

8

9}, Katherine S Takvorian⁶, Bernard E Kreger^{10

11}, Emelia J Benjamin^{11

12

13}, Wouter C Meijers², Stephan J L Bakker¹⁴, Lyanne M Kieneker¹⁴, Eke G Gruppen¹⁴, Bert van der Vegt¹⁵, Geertruida H de Bock¹⁶, Ron T Gansevoort¹⁴, Shehnaz K Hussain¹⁷, Udo Hoffmann^{18

19}, Greta Lee Splansky¹¹, Ramachandran S Vasan^{10

11

12

13}, Martin G Larson^{11

20}, Daniel Levy^{11

21}, Susan Cheng²², Rudolf A de Boer², Jennifer E Ho^{1

19}

Affiliations

¹ Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
² Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵ Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁷ Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ Division of Gastroenterology, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky, USA.
¹⁰ Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
¹¹ The Framingham Heart Study, Framingham, Massachusetts, USA.
¹² Cardiology and Preventative Medicine Sections, Boston University School of Medicine, Boston, Massachusetts, USA.
¹³ Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
¹⁴ Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁵ Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁶ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁷ Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, USA.
¹⁸ Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁹ Harvard Medical School, Boston, Massachusetts, USA.
²⁰ Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
²¹ Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
²² Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Abstract

Background: Obesity and cardiometabolic dysfunction have been associated with cancer risk and severity. Underlying mechanisms remain unclear.

Objectives: The aim of this study was to examine associations of obesity and related cardiometabolic traits with incident cancer.

Methods: FHS (Framingham Heart Study) and PREVEND (Prevention of Renal and Vascular End-Stage Disease) study participants without prevalent cancer were studied, examining associations of obesity, body mass index (BMI), waist circumference, visceral adipose tissue (VAT) and subcutaneous adipose tissue depots, and C-reactive protein (CRP) with future cancer in Cox models.

Results: Among 20,667 participants (mean age 50 years, 53% women), 2,619 cancer events were observed over a median follow-up duration of 15 years. Obesity was associated with increased risk for future gastrointestinal (HR: 1.30; 95% CI: 1.05-1.60), gynecologic (HR: 1.62; 95% CI: 1.08-2.45), and breast (HR: 1.32; 95% CI: 1.05-1.66) cancer and lower risk for lung cancer (HR: 0.62; 95% CI: 0.44-0.87). Similarly, waist circumference was associated with increased risk for overall, gastrointestinal, and gynecologic but not lung cancer. VAT but not subcutaneous adipose tissue was associated with risk for overall cancer (HR: 1.22; 95% CI: 1.05-1.43), lung cancer (HR: 1.92; 95% CI: 1.01-3.66), and melanoma (HR: 1.56; 95% CI: 1.02-2.38) independent of BMI. Last, higher CRP levels were associated with higher risk for overall, colorectal, and lung cancer (P < 0.05 for all).

Conclusions: Obesity and abdominal adiposity are associated with future risk for specific cancers (eg, gastrointestinal, gynecologic). Although obesity was associated with lower risk for lung cancer, greater VAT and CRP were associated with higher lung cancer risk after adjusting for BMI.

Keywords: BMI, body mass index; CRP, C-reactive protein; CT, computed tomographic; CVD, cardiovascular disease; HOMA-IR, homeostatic model assessment of insulin resistance; PAI, plasminogen activator inhibitor; SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue; WC, waist circumference; epidemiology; gastrointestinal cancer; inflammation; obesity; risk factor.

Abstract

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