Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 26;17(7):1117.
doi: 10.3390/cancers17071117.

Adherence to Antidiabetic Medication and Cardiovascular Outcomes in Cancer Patients: A Nationwide Population-Based Cohort Study

Mi-Hyang Jung  1   2 , Moon-Kyung Jung  1   2 , Eui-Soon Kim  1   2 , Jong-Chan Youn  1   2 , Eun Young Lee  3 , Dongwoo Kang  4 , Dae-Sung Kyoung  4 , Woo-Baek Chung  1   2 , Hae Ok Jung  1   2 , Sang-Hyun Ihm  2   5 , Hokyou Lee  6   7 , Choon Ta Ng  8 , Hyeon Chang Kim  6   7
Affiliations

Adherence to Antidiabetic Medication and Cardiovascular Outcomes in Cancer Patients: A Nationwide Population-Based Cohort Study

Mi-Hyang Jung et al. Cancers (Basel). .

Abstract

Background/objectives: Cancer survivors increasingly face cardiovascular disease (CVD), with diabetes as a major risk factor. This study investigates the relationship between adherence to antidiabetic medications and cardiovascular (CV) outcomes in cancer patients.

Methods: Using data from the Korean National Health Insurance Service-National Sample Cohort, we assessed the clinical outcomes of adult cancer patients prescribed antidiabetic medications. The study population was categorized based on medication adherence, as determined by the medication possession ratio (MPR): good (MPR ≥ 0.8), moderate (0.5 ≤ MPR < 0.8), and poor (MPR < 0.5) adherence. The primary outcomes included overall and CV mortality, with secondary outcomes encompassing hospitalization for major CVDs and healthcare costs.

Results: Among the 7928 cancer patients with diabetes, 59.7% were nonadherent (22.1% with moderate and 37.6% with poor adherence). Over a median follow-up of 5.7 years, 1462 deaths and 2897 CV events were confirmed. Multivariable adjusted analyses showed a 1.70-fold and 2.11-fold higher risk of overall mortality for the moderate and poor adherence groups, respectively, compared to the good adherence group. For CV mortality, moderate adherence was associated with a 1.51-fold higher risk, and poor adherence with a 2.10-fold higher risk. The risk for new-onset CV events increased by 1.32-fold in the moderate adherence group and 1.44-fold in the poor adherence group. The good adherence group also showed significantly lower total healthcare costs compared to the nonadherence group.

Conclusions: The present study underscores the importance of adherence to antidiabetic medications in cancer patients, revealing significant associations with decreased mortality, CV events, and healthcare costs.

Keywords: adherence; cancer; cardiovascular disease; diabetes; survivorship.

PubMed Disclaimer

Conflict of interest statement

Author Dongwoo Kang and Dae-Sung Kyoung were employed by the company Hanmi Pharm. Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study population enrollment. Abbreviations: CVD, cardiovascular disease.
Figure 2
Figure 2
Kaplan–Meier survival curves illustrating overall survival based on adherence to antidiabetic medications. The Kaplan–Meier curve demonstrated a significant difference in survival rates across adherence groups (log-rank p < 0.001), with the highest survival rate observed in the good adherence group, followed by the moderate and poor adherence groups. Pairwise comparisons showed statistically significant survival differences between all three groups. Asterisk (*) indicates p < 0.001 vs. good adherence; dagger (†) indicates p < 0.001 vs. moderate adherence. Shaded areas represent 95% confidence intervals. Abbreviations: MPR, medication possession ratio.
Figure 3
Figure 3
Healthcare cost per individual based on adherence to antidiabetic medications. The bars represent the mean healthcare cost per individual for each adherence category. There was a significant difference in healthcare cost per individual based on adherence to antidiabetic medications (p for trend < 0.001). Specifically, the group with good adherence showed a significantly lower healthcare cost per individual than the two other groups (moderate and poor adherence groups), as indicated by post hoc analysis (presented as an asterisk). As of 30 January 2024, USD 1 = KRW 1330.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71:209–249. - PubMed
    1. Miller K.D., Nogueira L., Devasia T., Mariotto A.B., Yabroff K.R., Jemal A., Kramer J., Siegel R.L. Cancer treatment and survivorship statistics, 2022. CA Cancer J. Clin. 2022;72:409–436. doi: 10.3322/caac.21731. - DOI - PubMed
    1. Raisi-Estabragh Z., Manisty C.H., Cheng R.K., Lopez Fernandez T., Mamas M.A. Burden and prognostic impact of cardiovascular disease in patients with cancer. Heart. 2023;109:1819–1826. doi: 10.1136/heartjnl-2022-321324. - DOI - PubMed
    1. Ahn Y., Jung M.H. Cardiovascular health is the essential but overlooked aspect in the management of cancer survivors. Eur. J. Prev. Cardiol. 2022;29:2322–2323. - PubMed
    1. Strongman H., Gadd S., Matthews A., Mansfield K.E., Stanway S., Lyon A.R., Dos-Santos-Silva I., Smeeth L., Bhaskaran K. Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: A population-based cohort study using multiple linked UK electronic health records databases. Lancet. 2019;394:1041–1054. - PMC - PubMed

LinkOut - more resources