Strong heart health lowers long-term death risk in cancer survivors

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Dec 17 2025

A major European study shows that simple, measurable heart health habits are linked to longer life after cancer, with inflammation and autonomic balance helping explain why.

Study: Life’s Simple 7 score and cardiovascular health in cancer survivors: the Moli-sani study. Image Credit: Explode / Shutterstock

In a recent study published in the European Heart Journal, researchers tested whether the American Heart Association’s (AHA) Life’s Simple 7 (LS7) cardiovascular health score predicts all-cause and cause-specific mortality in cancer survivors, and explored biological mediators linking LS7 to these outcomes.

Cardiovascular Risk After Cancer Survival

In Europe, approximately 12 to 14 million individuals are living with cancer. Many survive long enough that heart and vascular disease become competing causes of death alongside cancer. Daily habits such as smoking, diet, physical activity, and weight management can either increase or decrease this risk by affecting inflammation, metabolic stress, and blood pressure.

To address these modifiable factors, the AHA developed LS7, which evaluates seven lifestyle and clinical metrics: smoking, body mass index (BMI), physical activity, diet, blood pressure, total cholesterol, and glucose levels. Although LS7 has been linked to improved cardiovascular outcomes, the biological mechanisms connecting these behaviors to mortality in cancer survivors remain incompletely understood.

Cohort Design and LS7 Assessment

Researchers analyzed data from the population-based Moli-sani cohort, which included 24,325 adults living in Molise, Italy. Between 2005 and 2010, 779 cancer survivors were identified at baseline through self-reporting and confirmation using surgical, radiotherapy, or chemotherapy records.

Each of the seven LS7 components was scored from 0 to 2 points, yielding a total score ranging from 0 to 14. Scores were categorized as poor (0–6), intermediate (7–9), or ideal (10–14). Mortality data were obtained from the Registro Nominativo delle Cause di Morte (ReNCaM) and coded using the International Classification of Diseases, Ninth Revision (ICD-9).

Biomarkers, Mediation, and Statistical Methods

Baseline biomarker measurements included high-sensitivity C-reactive protein (CRP), lipid profiles, glucose, cystatin C, creatinine, insulin, C-peptide, vitamin D, and resting heart rate (RHR). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for multiple covariates.

Restricted cubic splines assessed dose–response relationships, while multiple imputation addressed missing data. Mediation analyses evaluated the contributions of inflammation, RHR, and vitamin D using a change-in-estimate approach with bootstrapping. Sensitivity analyses excluded early deaths, recent cancer diagnoses, and participants with baseline cardiovascular disease (CVD). Additional analyses substituted diet with a Mediterranean Diet Score (MDS) and applied a modified Life’s Essential 8 (LE8) score, excluding sleep.

Mortality Outcomes and Risk Associations

At baseline, participants had a mean age of 62.6 years, and 59.3% were female. The median LS7 score was 8, with 28.6% classified as having poor cardiovascular health, 51.4% intermediate, and 20.0% ideal.

Over a mean follow-up of 14.6 years, 269 deaths occurred, including 67 from CVD, 141 from cancer, and 54 from other causes. Compared with poor LS7 scores, intermediate and ideal scores were associated with 26% and 38% lower all-cause mortality, respectively. Each one-point increase in LS7 corresponded to an 11% reduction in the risk of all-cause mortality.

For cancer mortality, category-based comparisons showed similar trends but did not reach statistical significance for ideal versus poor scores. However, each one-point increase in LS7 was significantly associated with lower cancer mortality. Substituting diet with MDS modestly strengthened associations, and results were consistent when applying a modified LE8 score.

Component Contributions and Mediation Findings

Component-level analyses indicated that smoking and physical activity contributed most strongly to the protective association of LS7. Removing either component resulted in the greatest reduction in risk. Excluding total cholesterol strengthened associations, suggesting complex relationships rather than causal harm.

Mediation analyses revealed that high-sensitivity CRP explained approximately 19% of the association between LS7 and all-cause mortality. RHR accounted for about 31% of the association with both all-cause and cancer mortality, while vitamin D explained 17% to 26% of the association. Combined, these mediators explained roughly 58% of the association with all-cause mortality and 56% of the association with cancer mortality, supporting a shared biological pathway.

Interpretation and Clinical Implications

In this large community-based cohort of cancer survivors, higher LS7 scores were consistently associated with lower risks of all-cause and cancer mortality over nearly 15 years. Associations were linear, robust across sensitivity analyses, and partly explained by inflammation, autonomic regulation, and vitamin D status.

Although observational, the findings suggest that a single cardiovascular health score may help guide prevention strategies in cancer survivors and the general population. Future priorities include tailoring lifestyle counseling to cancer histories and testing interventions that improve LS7 components in real-world clinical settings.