Associations Between Fasting Glucose and Cardiovascular Disease Mortality in Cancer Survivors: A Population-based Cohort Study

Background and Objectives: Cardiovascular disease (CVD) prevention is an essential part of care among cancer survivors.Herein, we aimed to investigate the relationship between fasting glucose levels and the risk of CVD mortality among this population.Methods: Using data from the Korea National Health Insurance database, we identified patients with cancer who underwent health examination during 2009-2010 and survived for more than 5 years as of December 31, 2010.Individuals with a known CVD were excluded from the study.Individuals were categorized into 5 groups based on their fasting glucose levels.The clinical endpoint was CVD-related mortality.Results: Among 177,774 cancer survivors (mean age 60.711.9years, 57.8% female), we observed a reverse L-shaped association between fasting glucose levels and overall CVD mortality.After adjusting for covariates, the hazard ratios (95% confidence intervals [CIs]) were 1.14 (0.72-1.82), 1.00 (reference), 1.02 (0.94-1.11), 1.40 (1.24-1.58),and 2.28 (1.88-2.77)for fasting glucose <70, 70-99, 100-125, 126-179, and 180 mg/dL, respectively.Stratifying the results by age, increased risk of hypoglycemia (fasting glucose <70 mg/dL) for CVD mortality was significant in younger adults (<65 years) but not in older adults (65 years).Among younger adult cancer survivors, the adjusted hazard ratios (95% CIs) were 2. 97 (1.32-6.69),1.00 (reference), 0.95 (0.74-1.21), 1.58 (1.13-2.21),and 1.97 (1.19-3.26)for fasting glucose <70, 70-99, 100-125, 126-179, and 180 mg/dL, respectively.Conclusions: Elevated fasting glucose levels are associated with CVD mortality in cancer survivors.Additionally, hypoglycemia risk should not be overlooked in the younger adult subgroup.