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. 2025 Mar 21;4(1):e000909.
doi: 10.1136/bmjmed-2024-000909. eCollection 2025 Jan.

Associations between cardiometabolic comorbidities and mortality in adults with cancer: multinational cohort study

Veronica Davila-Batista  1   2   3 , Vivian Viallon  1 , Emma Fontvieille  1 , Anna Jansana  1 , Mirjam Kohls  1   4 , Nicola P Bondonno  5 , Anne Tjønneland  5   6 , Christina C Dahm  7 , Christian S Antoniussen  7 , Verena Katzke  8 , Rashmita Bajrachaya  8 , Matthias B Schulze  9   10 , Claudia Agnoli  11 , Fulvio Ricceri  12 , Salvatore Panico  13 , Raul Zamora-Ros  14 , Miguel Rodriguez-Barranco  3   15   16 , Pilar Amiano  3   17 , Maria-Dolores Chirlaque  3   18 , Conchi Moreno-Iribas  19 , Keren Papier  20 , Konstantinos K Tsilidis  21   22 , Dagfinn Aune  21   23   24 , Marc J Gunter  1   21 , Elisabete Weiderpass  1 , Mazda Jenab  1 , Pietro Ferrari  1 , Heinz Freisling  1
Affiliations

Associations between cardiometabolic comorbidities and mortality in adults with cancer: multinational cohort study

Veronica Davila-Batista et al. BMJ Med. .

Abstract

Objective: To examine separate and joint associations between pre-existing cardiometabolic comorbidities and all cause and cause specific mortality in adults with cancer.

Design: Multinational cohort study.

Setting: Seven European countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, 1 January 1992 to 31 December 2013.

Participants: 26 987 participants (54% women) who developed a first primary cancer. 2113 had a history of type 2 diabetes, 1529 had a history of cardiovascular disease, and 531 had a history of both, at the time of diagnosis of cancer.

Main outcome measures: Hazard ratios (95% confidence intervals, CIs) for associations between pre-existing cardiometabolic comorbidities and all cause and cause specific mortality in adults with cancer, estimated with multivariable Cox regression models. Associations were also estimated by groups of five year relative survival of cancer (survival ≤40%, 40-80%, and ≥80%) according to Surveillance, Epidemiology, and End Results (SEER) statistics, and for the most common site specific cancers.

Results: At the time of diagnosis of cancer, 84.5% (n=22 814) of participants had no history of a cardiometabolic disease, 7.8% (n=2113) had a history of type 2 diabetes, 5.7% (n=1529) had a history of cardiovascular disease, and 2.0% (n=531) had a history of both cardiovascular disease and type 2 diabetes. 12 782 deaths (10 492 cancer deaths) occurred over a mean follow-up period of 7.2 years. After multivariable adjustments, pre-existing comorbidities were positively associated with all cause mortality, with hazard ratios 1.25 (95% CI 1.17 to 1.34), 1.30 (1.21 to 1.39), and 1.60 (1.42 to 1.80) for participants with type 2 diabetes, cardiovascular disease, or both, respectively, compared with participants with no cardiometabolic comorbidity. Corresponding hazard ratios for cancer specific mortality were 1.13 (95% CI 1.05 to 1.22), 1.13 (1.04 to 1.23), and 1.33 (1.16 to 1.53), respectively. Associations for all cause mortality were stronger among participants with cancers with a five year relative survival ≥80%. In a subsample, duration of type 2 diabetes (Pinteraction=0.73) or cardiovascular disease (Pinteraction=0.24), categorised as <5 years or ≥5 years, did not modify associations between these comorbidities and all cause mortality.

Conclusions: In this study, cardiovascular disease or type 2 diabetes, or a combination of both, before a diagnosis of cancer, was associated with increased mortality (all cause mortality, and cancer and cardiovascular disease specific mortality). These findings support a direct role of cardiometabolic comorbidities on the prognosis of cancer.

Keywords: Diabetes mellitus; Epidemiology; Myocardial infarction; Stroke.

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Conflict of interest statement

All authors have completed the ICMJE unifform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the French National Cancer Institute and Cancéropôle Ile-de-France for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Authors identified as staff of the International Agency for Research on Cancer or World Health Organization are solely responsible for the views expressed in this article and their views do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or World Health Organization.

Figures

Figure 1
Figure 1. Kaplan-Meier curves for overall survival after a diagnosis of cancer by pre-existing cardiometabolic comorbidities, in participants with no pre-existing cardiometabolic comorbidities, and in those with type 2 diabetes, cardiovascular disease, and both type 2 diabetes and cardiovascular disease
Figure 2
Figure 2. Hazard ratios (95% confidence intervals, CIs) for associations between pre-existing cardiometabolic comorbidities and all cause and cause specific mortality in adults with cancer. Participants were grouped by age at recruitment, country, smoking status, stage of cancer, and five year relative survival of cancer, and adjusted for sex, educational level, alcohol intake, total energy intake, Mediterranean diet score, physical activity, body mass index, and hypertension, and menopausal status and hormone treatment (in women)
Figure 3
Figure 3. Hazard ratios (95% confidence intervals, CIs) for associations between pre-existing cardiometabolic comorbidities and all cause mortality in adults with cancer, by five year relative survival of the diagnosed cancer. Participants were grouped by age at recruitment, country, smoking status, and stage of cancer, and adjusted for sex, educational level, alcohol intake, total energy intake, Mediterranean diet score, physical activity, body mass index, and hypertension, and menopausal status and hormone treatment (in women). Five year relative survival according to the Surveillance, Epidemiology, and End Results (SEER) project (online supplemental table 1)
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