Association between fasting glucose and cardiovascular disease mortality in cancer survivors: a population-based study

Abstract

Abstract Background Prevention of subsequent cardiovascular disease (CVD) is an essential part of care among cancer survivors. Purpose We investigated the association of fasting blood sugar (FBS) with the risk of CVD mortality in cancer survivors. Methods Using nationwide cohort data, we included cancer patients who underwent health examination during 2009-2010 and survived more than 5 years as of Dec 31, 2010. We excluded those with known CVD. Participants were categorized into 5 groups by FBS levels. Clinical endpoint was mortality due to CVD (ischemic heart disease, stroke, heart failure, or sudden cardiac death). Results Among 177,774 cancer survivors (mean age 59.9 ± 23.0 years, female 59.1%), a reverse L-shaped association was observed between FBS and overall CVD mortality (Figure 1). Adjusted hazard ratios (95% confidence intervals) were 1.14 (0.72-1.81), 1.00 (reference), 1.02 (0.94-1.11), 1.40 (1.24-1.58), and 2.28 (1.88-2.77) for FBS <70, 70-99, 100-125, 126-179, and 180mg/dL, respectively. When we stratified by age, the risk of hypoglycemia (FBS < 70mg/dL) for CVD mortality was evident in middle aged adults (<65 years), but not in older adults (≥65 years) (Figure 2). Among middle aged cancer survivors, the adjusted hazard ratio (95% confidence intervals) were 2.97 (1.32-6.69), 1.00 (reference), 0.95 (0.74-1.21), 1.58 (1.13-2.21), and 1.97 (1.19-3.26) for FBS <70, 70-99, 100-125, 126-179, and 180mg/dL, respectively. Conclusion The strict control of elevated FBS is essential to prevent CVD mortality even in cancer survivors. Meanwhile, the risk of hypoglycemia in middle-aged cancer survivors should not be overlooked either.Figure 1Figure 2