Role of Cardiovascular Health in the Bidirectional Progression Trajectories Between Cardiovascular Disease, Type 2 Diabetes, and Cancer

There existed bidirectional associations of cardiovascular disease (CVD) and type 2 diabetes (T2D) with cancer, partly attributed to their shared risk factors. We aimed to explore the role of cardiovascular health (CVH) in bidirectional transitions between CVD, T2D, and cancer. Based on the UK Biobank, we used 2 subcohorts: a disease-free cohort of 277 997 individuals without cancer, CVD, and T2D; and a disease survivor cohort consisting of 61 971 cases with cancer, CVD, and T2D at baseline. The CVH was assessed on the basis of Life's Essential 8 score. We conducted the multistate model and Cox proportional hazards model to explore the role of CVH in bidirectional transitions between CVD, T2D, and cancer in disease-free and disease survivor cohorts, respectively. High CVH was significantly associated with a lower transition risk from CVD to cancer (hazard ratio, 0.822 [95% CI, 0.693-0.975]). On the other hand, increased CVH was related to reduced risks of progression from cancer to CVD and T2D (both P for trend<0.001), particularly in the high CVH group. For disease survivor cohorts, per 10-point increase in CVH was associated with >10% lower cancer risk in CVD and T2D cases, and a 16% and 42% reduction in the risk of incident CVD and T2D among cancer survivors, respectively. High CVH was related to a decreased risk of bidirectional transitions between CVD, T2D, and cancer. This highlighted the significance of maintaining high CVH throughout the life span for the primary prevention of CVD, T2D, and cancer.