Increased risk of cardiovascular disease associated with diabetes among adult cancer survivors: a population-based matched cohort study

Abstract

Diabetes was associated with an increased risk of cardiovascular disease in both adult cancer survivors and the general population. The magnitude of association between diabetes and cardiovascular disease was greater in adult cancer survivors than that in the general population. Lay Summary In a matched cohort of adult cancer survivors and the general population, diabetes was associated with a significantly higher risk of cardiovascular disease in adult cancer survivors compared to that in the general population. Aims Diabetes is a well-established risk factor for cardiovascular disease (CVD), but little is known about the differences in contribution of diabetes to incident CVD between adult cancer survivors and those without history of cancer. The aim of this study was to evaluate the magnitude of association between diabetes and CVD risk among adult cancer survivors and their general population counterparts. Methods and results The National Health Insurance Service database was used to abstract data on 5199 adult cancer survivors and their general population controls in a 1:1 age- and sex-matched cohort setting. The Cox proportional hazards model adjusted for socioeconomic status, health status, lifestyle, and clinical characteristics was used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) of incident CVD associated with glycaemic status in adult cancer survivors and the general population. The partial likelihood ratio test was used to compare the magnitude of the association between diabetes and CVD risk in the two groups. Compared to those without diabetes, adult cancer survivors (adjusted HR = 2.30; 95% CI: 1.24-4.30) and their general population controls (adjusted HR = 1.91; 95% CI: 1.02-3.58) with diabetes had a higher risk of incident cardiovascular outcomes. The magnitude of diabetes-CVD association was significantly stronger in adult cancer survivors than that in those without history of cancer (P = 0.011). Conclusions The magnitude of association between diabetes and incident CVD was stronger in adult cancer survivors as compared to that in their general population counterparts, supporting evidence for the importance of glycaemic control for prevention of CVD among those with history of cancer diagnosis and treatment.