Influence of ideal cardiovascular health behaviors and factors on the onset of primary liver cancer

Objective To investigate the influence of ideal cardiovascular health behaviors and factors on the onset of primary liver cancer in northern China. Methods A prospective cohort study was conducted for 95 055 on-the-job or retired employees of Kailuan Group who underwent physical examination from July 2006 to June 2007,and related data were collected. They were followed up to observe the onset of primary liver cancer. According to the cardiovascular health score( CHS),the subjects were divided into first quartile group with 27 143 subjects( CHS≤7),second quartile group with 35 488 subjects( 7 < CHS≤9),and third quartile group with 32 424 subjects( 9 < CHS≤14),and the person-year incidence rate was calculated. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups. The chi-square test was used for comparison of categorical data between groups. The life-table method was used to calculate the cumulative incidence rate of primary liver cancer,and the log-rank test was used for comparison of cumulative incidence rate between groups. The Cox proportional hazards model was used to analyze the influence of ideal cardiovascular health behaviors and factors on the onset of primary liver cancer. Results There were significant differences between the three groups in age,male/female ratio,body mass index,total cholesterol,fasting blood glucose,alanine aminotransferase,hypersensitive C-reactive protein,drinking,family income,educational level,fatty liver disease,family history of cancer,and proportion of subjects with ideal smoking,ideal physical exercise,ideal body mass index,ideal blood pressure,ideal total cholesterol,ideal blood glucose,and ideal diet ratio( all P < 0. 05). The mean follow-up time was 11. 49 ± 1. 86 years,and a total of 387 cases of primary liver cancer were observed,among whom there were 360 male and 27 female patients. The person-year incidence rates of the three groups were 4. 11/10 000 person-years,3. 78/10 000 person-years,and 2. 84/10 000 person-years,respectively. The 10-year cumulative incidence rates of the three groups were 4. 43‰,3. 61‰,and 2. 84‰,respectively,and there was a significant difference in the cumulative incidence rate between the three groups( χ2= 8. 29,P =0. 016). The Cox proportional hazards model showed that after adjustment for confounding factors( age,sex,alanine aminotransferase,hypersensitive C-reactive protein,drinking,family income,educational level,positive HBs Ag,liver cirrhosis,fatty liver disease,and family history of cancer),compared with the first quartile group,the second quartile group had a hazard ratio( HR) of 0. 87( 95% confidence interval [CI]: 0. 67-1. 13) and the third quartile group had an HR of 0. 74( 95% CI: 0. 56-0. 98)( P for trend < 0. 05). Conclusion The higher scores of ideal cardiovascular health behaviors and factors play a protective role in the onset of primary liver cancer,and the risk of primary liver cancer decreases with the increase in cardiovascular score.