Increased risk of multiple sclerosis among women with migraine in the Nurses’ Health Study II

Background: The prospective Nurses’ Health Study II (NHS-II), which enrolled over 116,000 female nurses, provides a unique opportunity to test the hypothesis of whether migraine is associated with multiple sclerosis (MS) and to explore the temporal aspects of the interrelationship. Objectives: To calculate relative risk of MS among NHS-II participants with and without migraine and to estimate odds ratio (OR) of being diagnosed with migraine in women with and without pre-existing MS. Methods: Cox proportional hazards regression was used to estimate rate ratios and 95% confidence intervals (CIs) of being diagnosed with MS in women with and without pre-existing migraine adjusted for potential confounders. Multivariate adjusted ORs of being diagnosed with migraine in women with and without pre-existing MS were estimated using logistic regression. Results: The prevalence of migraine in women with MS at baseline (26%, p = 0.11) and those diagnosed with MS after enrolment (29%, p < 0.0001) was higher than in the non-MS cases (21%). The relative risk of developing MS in migraineurs was 1.39 times higher than in non-migraineurs (95% CI 1.10–1.77, p = 0.008). The absolute risk of developing MS in women migraineurs over a 15-year follow-up was 0.47% and among non-migraineurs 0.32%. The odds of being diagnosed with migraine was higher in women with pre-existing MS compared with those without MS, but did not reach statistical significance (OR = 1.57, 95% CI 0.97–2.52; p = 0.06). Conclusions: Using a large, cohort of women-nurses, history of migraine was associated with an increased risk of MS. However, the difference in absolute risk of MS in migraineurs and non-migraineurs was small.

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Rotating night shift work and risk of multiple sclerosis in the Nurses’ Health Studies

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-106016 ◽

2019 ◽

Vol 76 (10) ◽

pp. 733-738 ◽

Cited By ~ 1

Author(s):

Kyriaki Papantoniou ◽

Jennifer Massa ◽

Elizabeth Devore ◽

Kassandra L Munger ◽

Tanuja Chitnis ◽

...

Keyword(s):

Multiple Sclerosis ◽

Shift Work ◽

Proportional Hazards ◽

Night Shift ◽

Cox Proportional Hazards ◽

Health Study ◽

Work History ◽

Night Shift Work ◽

Increased Risk ◽

History Of

ObjectivesNight shift work has been suggested as a possible risk factor for multiple sclerosis (MS). The objective of the present analysis was to prospectively evaluate the association of rotating night shift work history and MS risk in two female cohorts, the Nurses’ Health Study (NHS) and NHSII.MethodsA total of 83 992 (NHS) and 114 427 (NHSII) women were included in this analysis. We documented 579 (109 in NHS and 470 in NHSII) incident physician-confirmed MS cases (moderate and definite diagnosis), including 407 definite MS cases. The history (cumulative years) of rotating night shifts (≥3 nights/month) was assessed at baseline and updated throughout follow-up. Cox proportional hazards models were used to estimate HRs and 95% CIs for the association between rotating night shift work and MS risk adjusting for potential confounders.ResultsWe observed no association between history of rotating night shift work and MS risk in NHS (1–9 years: HR 1.03, 95% CI 0.69 to 1.54; 10+ years: 1.15, 0.62 to 2.15) and NHSII (1–9 years: HR 0.90, 95% CI 0.74 to 1.09; 10+ years: 1.03, 0.72 to 1.49). In NHSII, rotating night shift work history of 20+ years was significantly associated with MS risk, when restricting to definite MS cases (1–9 years: HR 0.88, 95% CI 0.70 to 1.11; 10–19 years: 0.98, 0.62 to 1.55; 20+ years: 2.62, 1.06 to 6.46).ConclusionsOverall, we found no association between rotating night shift work history and MS risk in these two large cohorts of nurses. In NHSII, shift work history of 20 or more years was associated with an increased risk of definite MS diagnosis.

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Association of oral contraceptives and tubal ligation with risk of early natural menopause

Human Reproduction ◽

10.1093/humrep/deab054 ◽

2021 ◽

Author(s):

C R Langton ◽

B W Whitcomb ◽

A C Purdue-Smithe ◽

L L Sievert ◽

S E Hankinson ◽

...

Keyword(s):

Oral Contraceptives ◽

Proportional Hazards ◽

Reproductive Factors ◽

Cox Proportional Hazards ◽

Tubal Ligation ◽

Health Study ◽

Early Menopause ◽

Natural Menopause ◽

Increased Risk

Abstract STUDY QUESTION What is the association of oral contraceptives (OCs) and tubal ligation (TL) with early natural menopause? SUMMARY ANSWER We did not observe an association of OC use with risk of early natural menopause; however, TL was associated with a modestly higher risk. WHAT IS KNOWN ALREADY OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of early menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. STUDY DESIGN, SIZE, DURATION We examined the association of OC use and TL with natural menopause before the age of 45 years in a population-based study within the prospective Nurses’ Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until early menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. MAIN RESULTS AND THE ROLE OF CHANCE Over 1.6 million person-years, 2579 members of the analytic cohort experienced early natural menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of early menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for early menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of early menopause (HR = 1.17, 95% CI, 1.06-1.28). LIMITATIONS, REASONS FOR CAUTION Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the largest study examining the association of OC use and TL with early natural menopause to date. While TL was associated with a modest higher risk of early menopause, our findings do not support any material hazard or benefit for the use of OCs. STUDY FUNDING/COMPETING INTEREST(S) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A

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Abstract MP49: Sugar Sweetened and Artificially Sweetened Beverages and risk of Mortality in US adults

Circulation ◽

10.1161/circ.129.suppl_1.mp49 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Vasanti S Malik ◽

An Pan ◽

Lawrence de Koning ◽

Eva Schernhammer ◽

Walter C Willett ◽

...

Keyword(s):

Proportional Hazards ◽

Total Mortality ◽

Cox Proportional Hazards ◽

Health Study ◽

Sweetened Beverages ◽

Risk Of Mortality ◽

Regular Consumption ◽

Increased Risk ◽

Artificially Sweetened Beverages ◽

Cvd Mortality

Background: Sugar sweetened beverages (SSBs) are the single largest source of calories and added sugars in the US diet and regular consumption has been associated with weight gain and risk of chronic diseases. Artificially sweetened beverages (ASBs) are often suggested as alternatives to SSB but little is known about their long-term health effects. Whether consumption of SSBs or ASBs is associated with risk of mortality is unknown. Methods: We prospectively followed 38,602 men from the Health Professional’s Follow-up study (1986-2010) and 82,592 women from the Nurses’ Health study (1980-2010) who were free from cardiovascular disease (CVD) and cancer at baseline. Diet was assessed using validated food frequency questionnaires every 4 years and Cox Proportional Hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: We documented 27,691 deaths (6,631 CVD and 10,447 cancer deaths) during 3.14 million person-years. After adjusting for major dietary and lifestyle risk factors, and BMI, baseline diabetes, hypertension and hypercholesterolemia, consumption of SSBs was associated with an increased risk of total mortality, which was mainly driven by CVD mortality among individuals consuming at least 2 servings per day; pooled HRs (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.95 (0.91, 0.98), 0.96 (0.93, 0.99), 1.02 (0.96, 1.08), and 1.18 (1.04, 1.33), respectively (P-trend= 0.0001) for total mortality, and 1.00, 0.97 (0.90, 1.02), 0.96 (0.90, 1.02), 1.04 (0.93, 1.16) and 1.28 (1.09, 1.51), respectively (P-trend=0.007) for CVD mortality. In contrast, ASBs were not associated with mortality; pooled HR’s (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.92 (0.89, 0.95), 0.91 (0.86, 0.97), 0.91 (0.86, 0.95) and 0.99 (0.85, 1.15), respectively (P-trend=0.50) for total mortality and 1.00, 0.86 (0.80, 0.92), 0.87 (0.81, 0.94), 0.96 (0.88, 1.06) and 0.96 (0.74, 1.25), respectively (P-trend=0.99) for CVD mortality. No associations were observed with cancer mortality for either SSBs or ASBs in multi-variable adjusted models. Conclusion: Regular consumption of SSBs is associated with an increased risk of total and CVD mortality, providing additional support for recommendations and policies to limit intake of these beverages.

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Sedentary Behaviors, TV Viewing Time, and Risk of Young-Onset Colorectal Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pky073 ◽

2018 ◽

Vol 2 (4) ◽

Cited By ~ 18

Author(s):

Long H Nguyen ◽

Po-Hong Liu ◽

Xiaobin Zheng ◽

NaNa Keum ◽

Xiaoyu Zong ◽

...

Keyword(s):

Colorectal Cancer ◽

Proportional Hazards ◽

Statistical Tests ◽

Cox Proportional Hazards ◽

Health Study ◽

Viewing Time ◽

Sedentary Behaviors ◽

Tv Viewing ◽

Young Onset ◽

Increased Risk

Abstract Background Colorectal cancer (CRC) diagnosed before age 50 years, or young-onset CRC, is increasing globally with undefined etiology. A sedentary lifestyle is an emerging risk factor for CRC after age 50 years, but its role in young-onset CRC is unknown. Methods We prospectively evaluated sedentary behaviors, primarily time watching television (TV), and risk of young-onset CRC among 89 278 women in the Nurses’ Health Study II ages 25–42 years at recruitment (1991–2011). We used Cox proportional hazards modelling to estimate relative risks (RR) and 95% confidence intervals (CIs). Statistical tests were two-sided. Results We documented 118 young-onset CRCs over 1 262 540 person-years. Sedentary TV viewing time was statistically significantly associated with increased risk of young-onset CRC, after adjusting for putative risk factors, including obesity and physical activity. Compared to no more than 7 hours per week, women with 7.1–14 hours per week of TV time had a multivariable relative risk (RR) of 1.12 (95% confidence interval [CI] = 0.72 to 1.75), further increased for greater than 14 hours per week (RR = 1.69, 95% CI = 1.07 to 2.67, Ptrend = .03). This association was observed among participants without a CRC family history and was more pronounced for rectal cancer (RR for >14 vs ≤7 hours per week 2.44, 95% CI = 1.03 to 5.78, Ptrend = .04). Overweight or obese participants may be more susceptible. Conclusion Independent of exercise and obesity, prolonged sedentary TV viewing time, a surrogate for a more inactive lifestyle, was associated with increased risk of young-onset CRC, particularly of the rectum. These findings provide further evidence on the importance of maintaining an active lifestyle.

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Childhood body mass index and multiple sclerosis risk: a long-term cohort study

Multiple Sclerosis Journal ◽

10.1177/1352458513483889 ◽

2013 ◽

Vol 19 (10) ◽

pp. 1323-1329 ◽

Cited By ~ 143

Author(s):

Kassandra L Munger ◽

Joan Bentzen ◽

Bjarne Laursen ◽

Egon Stenager ◽

Nils Koch-Henriksen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Body Mass Index ◽

Body Mass ◽

School Health ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Z Score ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Unit Increase

Background: Obesity in late adolescence has been associated with an increased risk of multiple sclerosis (MS); however, it is not known if body size in childhood is associated with MS risk. Methods: Using a prospective design we examined whether body mass index (BMI) at ages 7–13 years was associated with MS risk among 302,043 individuals in the Copenhagen School Health Records Register (CSHRR). Linking the CSHRR with the Danish MS registry yielded 774 MS cases (501 girls, 273 boys). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among girls, at each age 7–13 years, a one-unit increase in BMI z-score was associated with an increased risk of MS (HRage 7=1.20, 95% CI: 1.10–1.30; HRage 13=1.18, 95% CI: 1.08–1.28). Girls who were ≥95th percentile for BMI had a 1.61–1.95-fold increased risk of MS as compared to girls <85th percentile. The associations were attenuated in boys. The pooled HR for a one-unit increase in BMI z-score at age 7 years was 1.17 (95% CI: 1.09–1.26) and at age 13 years was 1.15 (95% CI: 1.07–1.24). Conclusion: Having a high BMI in early life is a risk factor for MS, but the mechanisms underlying the association remain to be elucidated.

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Prediabetes, Diabetes, and the Risk of All-Cause and Cause-Specific Mortality in a Japanese Working Population: Japan Epidemiology Collaboration on Occupational Health Study

10.2337/figshare.13483515 ◽

2021 ◽

Author(s):

Zobida Islam ◽

Shamima Akter ◽

Yosuke Inoue ◽

Huan Hu ◽

Keisuke Kuwahara ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

World Health ◽

Health Study ◽

Expert Committee ◽

Risk Of Mortality ◽

Japanese Workers ◽

Increased Risk ◽

Health Organization

Objective: Prediabetes has been suggested to increase mortality risk; however, the definitions of prediabetes that can predict mortality remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of mortality from all-causes, cardiovascular disease (CVD), and cancer in Japanese workers. Research design and methods: The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for mortality from 2012 to March 2019. <a>Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) level or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. </a>The Cox proportional hazards regression model was used to investigate the associations. Results: Over a 7-year follow-up, 229 deaths were documented. <a>Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause (hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.12–2.09) and cancer (HR 2.37; 95% CI 1.45–3.89) mortality but not with CVD mortality. </a>The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA1c, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer mortality. Conclusion: In a cohort of Japanese workers, FPG- and HbA1c-defined prediabetes according to ADA or WHO/IEC was each associated with a significantly increased risk of mortality from all-causes and cancer but not CVD.

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863Alcohol and cancer in an Australian cohort of 226,162 participants aged 45 years and over

International Journal of Epidemiology ◽

10.1093/ije/dyab168.581 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Peter Sarich ◽

Karen Canfell ◽

Sam Egger ◽

Emily Banks ◽

Grace Joshy ◽

...

Keyword(s):

Alcohol Consumption ◽

Cancer Risk ◽

Proportional Hazards ◽

Absolute Risk ◽

Cox Proportional Hazards ◽

Inverse Association ◽

Upper Aerodigestive Tract ◽

Public Health Burden ◽

Local Evidence ◽

Increased Risk

Abstract Background Australia has a relatively high level of alcohol consumption. Although alcohol consumption is known to increase the risk of several cancer types internationally, local evidence for Australia is limited. Methods Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to weekly alcohol consumption among 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident cancer cases were ascertained by linkage to the New South Wales Cancer Registry to December 2013 by the Centre for Health Record Linkage. Results Over a median 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of any cancer (HR per seven drink increase in weekly consumption: 1.02; 95% CI: 1.00-1.04), and cancers of the upper aerodigestive tract (1.19;1.10-1.29), mouth/pharynx (1.18;1.08-1.29), oesophagus (1.22;1.04-1.43), colorectum (1.09;1.04-1.15), colon (1.13;1.06-1.20), liver (1.22;1.04-1.44), breast (1.09;1.00-1.18), and melanoma (1.05;1.00-1.10); whereas an inverse association was observed for thyroid cancer (0.80;0.64-1.00). We estimated that by age 85 years, Australian men and women who consume >14 drinks/week increase their absolute risk of alcohol-attributable cancer by 4.4% and 5.4%, respectively, compared to non-drinkers. Conclusions We report relative risks of cancer incidence in relation to alcohol consumption that match the international evidence. In Australia, a nation with relatively high alcohol consumption, these risks may translate into a significant public health burden. Key messages We have generated estimates for the relationship between alcohol consumption and cancer risk in Australia.

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Effect of Physical Comorbidities on Risk of Depression in Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073-11.4.161 ◽

2009 ◽

Vol 11 (4) ◽

pp. 161-165 ◽

Cited By ~ 3

Author(s):

Ruth Ann Marrie ◽

Gary Cutter ◽

Tuula Tyry ◽

Denise Campagnolo ◽

Timothy Vollmer

Keyword(s):

Multiple Sclerosis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Research Committee ◽

The North ◽

Increased Risk

Depression in multiple sclerosis (MS) may be due to several factors, including the presence of physical comorbidities. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we examined whether individuals with MS and physical comorbidities have an increased risk of depression compared with those without physical comorbidities and whether they are more likely to remain untreated for depression. In 2006, NARCOMS participants reported their physical and mental comorbidities and completed the Center for Epidemiologic Studies Depression Scale (CESD). We defined a CESD score of 21 or higher as indicating probable major depression. Individuals with elevated CESD scores but no diagnosis of depression were considered undiagnosed. Forty-six percent of participants reported a lifetime history of depression. In a multivariable Cox proportional hazards model, reporting any physical comorbidity was associated with an increased risk of being diagnosed with depression (hazard ratio [HR], 2.20; 95% confidence interval [CI], 2.04–2.38) after MS onset and with an increased risk of diagnosed or undiagnosed depression (HR, 2.37; 95% CI, 2.21–2.54). After adjustment for education, participants with any physical comorbidity were more likely to report treatment for depression (odds ratio [OR], 1.67; 95% CI, 1.24–2.23). Patients with MS and physical comorbidities are at increased risk of depression, but they are more likely to be diagnosed and treated than MS patients without other chronic conditions.

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Corrected QT Interval Is Associated With Stroke but Not Coronary Heart Disease: Insights From a General Chinese Population

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.605774 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaofan Guo ◽

Zhao Li ◽

Ying Zhou ◽

Shasha Yu ◽

Hongmei Yang ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Chinese Population ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Cardiovascular Health Study ◽

Qtc Interval ◽

Increased Risk ◽

General Chinese Population

Background: Prolonged heart rate-corrected QT (QTc) interval has been associated with incident cardiovascular diseases (CVD) in general Western populations. However, this association is unclear in Asian population. We aim to estimate the association between QTc interval and incident CVD in a general Chinese population.Methods: We analyzed 8,867 participants age ≥35 years and free of CVD at baseline in the Northeast China Rural Cardiovascular Health Study. A resting 12-lead electrocardiogram was performed on all participants, and QTc interval computed using the Framingham formula. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for associations between QTc interval and incident stroke, coronary heart disease, and combined CVD events.Results: Over a median follow-up of 4.66 years, a total of 439 CVD events occurred (298 stroke cases and 152 CHD cases). After full adjustment, prolonged QTc defined by a sex-specific cutoff was associated with increased risk of developing stroke (HR: 1.82, 95% CI 1.20–2.75, P = 0.004) and combined CVD (HR: 1.52, 95% CI 1.05–2.19, P = 0.026). Spline analyses demonstrated no clear thresholds; when modeled as a linear relationship, each 10 ms increase of QTc interval was associated with an HR of 1.12 (95% CI 1.06–1.19, P < 0.001) for stroke and an HR of 1.10 (95% CI 1.05–1.15, P < 0.001) for combined CVD. Baseline QTc interval was not associated with incident CHD with either modeling strategy.Conclusions: Baseline QTc interval is associated with incident stroke and CVD in adults without prior CVD from a general Chinese population.

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506 Role of inflammation and comorbidities in the association between heart failure and incident cancer in the HUNT3 cohort

European Heart Journal Supplements ◽

10.1093/eurheartj/suab130 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Edoardo Bertero ◽

Luca Carmisciano ◽

Christian Jonasson ◽

Christoph Maack ◽

Pietro Ameri

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Chronic Obstructive ◽

Low Grade ◽

Incident Cancer ◽

Increased Risk ◽

Risk Of Cancer ◽

Low Grade Inflammation

Abstract Aims Conflicting data exist regarding the risk of cancer in patients with heart failure (HF). It was first reported that incident cancer is more common among patients with than without HF, whereas more recent studies indicate that this association is primarily driven by comorbidities. HF, cancer, and comorbidities, such as chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), share numerous risk factors, including a state of chronic low-grade inflammation reflected by elevated circulating levels of pro-inflammatory cytokines. The objective of this analysis was to assess whether chronic low-grade inflammation, as measured by levels of high-sensitivity C-reactive protein (hsCRP), and comorbidities mediate the association of HF with incident cancer. Methods We used data from the 3rd wave of the Nord-Trøndelag Health Study (HUNT3), a population-based study that enrolled 50 803 individuals ≥18-year-old between October 2006 and June 2008 in the Nord-Trøndelag County (Norway), and from the administrative health care records of the same region. Associations between baseline characteristics and the development of cancer were assessed using Cox proportional hazards regression models, using time from HUNT3 enrolment as the time scale. Analyses were performed using R statistical software, version 4.0.2. Results In HUNT3, hsCRP was measured in 47 571 individuals at the time of enrolment. Of these, we excluded 2308 patients because of missing information, leaving a cohort of 45 263 subjects. The prevalence of cardiovascular disease, comorbidities, and obesity was progressively higher with increasing concentrations of hsCRP. During a median follow-up of 12 years, there were 66/408 cases of incident cancer in patients with HF at baseline and 5024/47 163 in subjects without HF, with a more than 2-fold (HR 2.30; 95% CI 1.80–2.93; P < 0.001) increase in risk of developing cancer. After adjusting for age and sex, the excess risk decreased to 43% (HR 1.43; 95% CI 1.12–1.82). When including hsCRP in the model, the HF-related risk of cancer was 33% (HR 1.33; 95% CI 1.04–1.70; P = 0.022). Furthermore, when body mass index, CKD, COPD, and smoking and drinking habits were included in the model, the risk of cancer in HF patients compared to individuals without HF was no longer significant (HR 1.23; 95% CI 0.94–1.60; P = 0.127). Age, male sex, hsCRP, COPD, obesity, and smoking habits were all associated with an increased risk of cancer. Conclusions The increased risk of cancer in HF patients compared with the general population is at least in part explained by concomitant inflammation and comorbidities.

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