Comprehensive multiple risk factor control in cancer survivors to mitigate heart failure risk: insights from a prospective cohort study

Abstract Aims Cancer survivors experience higher risk of heart failure (HF) compared to individuals without cancer. We aimed to evaluate the association between comprehensive risk factor control with incident HF among cancer survivors. Methods and results We included a total of 14,466 cancer survivors and matched with 57,864 control counterparts without cancer from the UK Biobank cohort. Joint risk factor control was assessed based on blood pressure, body mass index, low-density lipoprotein cholesterol, hemoglobin A1c, renal function, smoking, physical activity, and diet quality. Cox proportional hazards models were used to estimate associations between the degree of risk factor control and risk of HF. R2 values of the Cox models were calculated to determine the relative importance of these modifiable risk factors. During a median follow-up of 12.54 years, 572 cancer survivors and 1,851 matched control participants developed HF. After adjustment for potential confounders, each additional controlled risk factor was associated with a 12% reduction in HF risk (HR: 0.88, 95% CI: 0.81–0.96). Joint control for at least 5 risk factors in cancer survivors was related to 24% lower HF risk (HR: 0.76, 95% CI: 0.61–0.95) compared to the lowest risk factor control group, and shared a similar HF risk with matched controls. Conclusion Among cancer survivors, we observed a graded inverse association between the level of joint risk factor control and the risk of HF.