ASSOCIATION BETWEEN DIET QUALITY AND CARDIOVASCULAR DISEASE MORTALITY IN CANCER SURVIVORS IN THE UNITED STATES
Author(s)
Anh Le, BS, MSc, Nguyen D. Le, BSc, MBA, Chanhyun Park, MEd, RPh, PhD;
The University of Texas at Austin, Austin, TX, USA
The University of Texas at Austin, Austin, TX, USA
OBJECTIVES: Cardiovascular disease (CVD) is a leading non-cancer cause of death among U.S. cancer survivors, potentially driven by cardiotoxic cancer therapies and shared risk factors. Diet quality is increasingly recognized as a modifiable factor in survivorship care, yet evidence linking overall diet quality to CVD mortality in cancer survivors remains limited. We evaluated the association between diet quality, measured by the Healthy Eating Index (HEI), and 10-year CVD-related mortality among U.S. cancer survivors.
METHODS: This U.S. population-level survey-based longitudinal cohort analysis used 2005-2018 National Health and Nutrition Examination Survey (NHANES) data and linked to the 2019 Public-Use Linked Mortality Files. The index date was the NHANES survey date with follow-up through mortality linkage. The primary outcome was CVD-related death. Diet quality was measured using the Healthy Eating Index (HEI), including total HEI and component scores, dichotomized as qualified vs unqualified (total HEI >59; component score >59% of the maximum). Fine-Gray competing-risk models with g-computation estimated population average treatment effects (PATEs) for the 10-year cumulative incidence function (CIF), adjusting for demographics, socioeconomic status, cancer site, physical activity, hypertension, dyslipidemia, and diabetes. Ninety-five percent confidence intervals were obtained using 1,000 bootstrap iterations.
RESULTS: The analytic sample included 2,403 cancer survivors with two 24-hour dietary recalls, representing 18,988,543 weighted participants; median follow-up was 77 months (IQR 43-120). Weighted counts were 11,724,521 in the unqualified total HEI group and 7,264,022 in the qualified group. The crude PATE for 10-year CVD death CIF was 0.11% (95% CI −1.61% to 1.98%). After adjustment, the PATE was 0.50% (95% CI −3.59% to 4.64%).
CONCLUSIONS: Dichotomized total HEI was not clearly associated with 10-year CVD mortality in U.S. cancer survivors. Future studies should evaluate HEI continuously, examine specific dietary components, and clinically define survivor subgroups to identify potentially relevant targets for CVD risk reduction.
METHODS: This U.S. population-level survey-based longitudinal cohort analysis used 2005-2018 National Health and Nutrition Examination Survey (NHANES) data and linked to the 2019 Public-Use Linked Mortality Files. The index date was the NHANES survey date with follow-up through mortality linkage. The primary outcome was CVD-related death. Diet quality was measured using the Healthy Eating Index (HEI), including total HEI and component scores, dichotomized as qualified vs unqualified (total HEI >59; component score >59% of the maximum). Fine-Gray competing-risk models with g-computation estimated population average treatment effects (PATEs) for the 10-year cumulative incidence function (CIF), adjusting for demographics, socioeconomic status, cancer site, physical activity, hypertension, dyslipidemia, and diabetes. Ninety-five percent confidence intervals were obtained using 1,000 bootstrap iterations.
RESULTS: The analytic sample included 2,403 cancer survivors with two 24-hour dietary recalls, representing 18,988,543 weighted participants; median follow-up was 77 months (IQR 43-120). Weighted counts were 11,724,521 in the unqualified total HEI group and 7,264,022 in the qualified group. The crude PATE for 10-year CVD death CIF was 0.11% (95% CI −1.61% to 1.98%). After adjustment, the PATE was 0.50% (95% CI −3.59% to 4.64%).
CONCLUSIONS: Dichotomized total HEI was not clearly associated with 10-year CVD mortality in U.S. cancer survivors. Future studies should evaluate HEI continuously, examine specific dietary components, and clinically define survivor subgroups to identify potentially relevant targets for CVD risk reduction.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH204
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Oncology, STA: Nutrition