The association of traditional risk factors with cancer and cardiovascular disease is modified differentially by inflammatory marker

Cardiovascular disease (CVD) and cancer are associated with shared common risk factors. The purpose of the current analysis was to investigate how neutrophils to lymphocytes ratio (NLR), a marker of inflammation, modifies these associations. Methods: Historical prospective study of self-referred subjects enrolled in a screening program (2000-2017). All subjects completed comprehensive evaluation including exercise stress test. CVD was defined as acute coronary syndrome, percutaneous coronary intervention or cerebrovascular accident, and was retrieved from annual visits data and hospitalization records. Survival cancer data were available for all subjects from national registries. Results: Final study population included 17,984 participants (71% men) with a median age of 49 (Interquartile range [IQR] 44-55). During a median follow up of 12 years (IQR 7-16) 1,242 (7%) patients developed cancer and 1,028 (6%) developed CVD. Multivariable Cox regression analysis showed that age, low high-density lipoprotein (HDL), smoking and high neutrophil-to-lymphocyte (NLR) were all associated with both cancer and CVD occurrence during follow up (p < 0.05 for all). In contrast, triglycerides, male sex and low cardiorespiratory fitness were all associated with increased risk of CVD but not cancer. Interaction analysis demonstrated that the association of low HDL with CVD, but not with cancer, was modified by NLR such that among patients with high NLR the risk of CVD was lower (HR 1.0 vs 1.3 p for interaction = .04). Conclusions: Our analysis support previous observation regarding shared common risk factors for cancer and CVD. However, this analysis shows that the association of low HDL with CVD but not with cancer is mediated through inflammation as represented by NLR.