Cardio-kidney metabolic health among adult cancer survivors in the Hispanic Community Health Study/Study of Latinos

Background: Compared to the general population, cancer survivors are at higher risk for cardiovascular, kidney, and metabolic (CKM) diseases. However, the prevalence and progression of CKM diseases among Hispanic/Latino adults with a history of cancer remain underexplored. Using data from the community-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we examined the changes in CKM diseases and predictors of CKM disease progression over an average of six years, stratified by baseline cancer history. Methods: We included 16,415 participants from the HCHS/SOL with a history of cancer (n=644) and without a history of cancer (n=15,771) at Visit 1 in 2008-2011. CKM stage at Visit 1 and Visit 2 in 2014-2017 was defined according to the 2023 American Heart Association(AHA)'s CKM stage framework. The 2023 AHA advisory defines five CKM stages (0-4), progressing from no CKM risk factor (stage 0) to excess or dysfunctional adiposity (stage 1), metabolic syndrome or chronic kidney disease (stage 2), subclinical cardiovascular disease or risk equivalent (stage 3), and established cardiovascular disease (stage 4). Descriptive statistics were used to assess the prevalence and transition of CKM stage between visits. Survey-weighted multivariable logistic models and Fine-Gray competing risk models were used to evaluate the associations (odds ratios, ORs, and 95% confidence intervals, CIs) between cancer history and sociodemographic factors and CKM stage progression. Results: Compared to those without a history of cancer, those with a history of cancer were older (mean age±standard error = 55.8±1.0 versus 47.4±0.2 years), more likely to be female (65.4% versus 52.7%), retired (29.0% versus 10.6%), have an annual household income <$20,000 (54.9% versus 47.5%), and be physically inactive (45.0% versus 36.4%). Cancer survivors had a higher prevalence of advanced CKM stages (≥ stage 3) at both Visit 1 (24.2% versus 10.0%) and Visit 2 (35.3% versus 16.9%). While the proportions of CKM worsening were similar between groups, cancer survivors had a significantly higher mortality rate (12.2% vs 4.8%) during follow-up. Cancer history itself was not a predictor of CKM worsening after adjusting for sociodemographic factors (OR = 1.03; 95% CI = 0.75-1.43). After accounting for competing mortality, cancer survivors were 37% less likely to experience CKM stage progression than those without a cancer history (HR = 0.63; 95%CI = 0.47-0.83; P <0.01). Conclusion: CKM diseases are prevalent among Hispanic adults, with cancer survivors experiencing more advanced CKM stages and higher mortality rates over time than those without a history of cancer.