Dual-trajectories of systolic blood pressure and life’s essential 8 with gastrointestinal cancer and all-cause mortality: a prospective cohort study

Abstract

Background and aims: Elevated systolic blood pressure (SBP) has been shown to be associated with an increased risk of gastrointestinal cancer and all-cause mortality. However, the joint longitudinal patterns of SBP levels and cardiovascular health, as assessed by Life’s essential 8 (LE8), and their impact on the risks of gastrointestinal cancer and all-cause mortality remain unclear. Therefore, we aimed to describe the joint longitudinal patterns of SBP levels and cardiovascular health and to further investigate their associations with the risks of gastrointestinal cancer and all-cause mortality. Methods All participants were drawn from the Kailuan Study, a large-scale, ongoing prospective cohort study. Participants who attended both the 2006/2007 and 2014/2015 surveys and at least one survey between these two surveys were included. We defined the time from the 2006/2007 survey to the 2014/2015 survey as the exposure period to identify the joint longitudinal patterns of SBP levels and LE8 scores, and used the 2014/2015 survey as the baseline for follow-up and further observed the onset of all-cause mortality and gastrointestinal cancer during the period of 2015-2022. A group-based dual-trajectory model was used to characterize the joint longitudinal patterns of SBP levels and LE8 scores. Multivariable Cox proportional hazards regression models were used to assess the associations of dual-trajectories pattern of SBP and LE8 with the risks of gastrointestinal cancer and all-cause mortality (hazard ratio, HR and 95% confidence interval, 95% CI). Results A total of 48,596 participants were included in the analysis of the association of dual-trajectories of SBP and LE8 with the risk of gastrointestinal cancer, and 49,524 participants were included in the analysis of all-cause mortality, with five dual-trajectory group identified. Compared with the group 3, group 2 characterized by high SBP level and very low LE8 scores had the highest risk of gastrointestinal cancer (HR, 1.64; 95% CI, 1.17-2.29), followed by group 4 (HR, 1.53; 95% CI, 1.09-2.16) and group 5 (HR, 1.26; 95% CI, 1.26-1.71), whereas group 1, characterized by low SBP level and low LE8 scores, had the lowest risk of gastrointestinal cancer (HR, 1.09; 95% CI, 0.78-1.51), although the association was not statistically significant. Similar results were observed for the associations between dual-trajectory of SBP and LE8 scores and all-cause mortality. Conclusions This study found the joint longitudinal patterns of SBP levels and LE8 scores and revealed their associations with the risks of gastrointestinal cancer and all-cause mortality. The findings suggest that individuals with lower LE8 scores higher risks of gastrointestinal cancer and all-cause mortality even at similar SBP levels, underscoring the importance of comprehensive cardiovascular health for risk stratification and prevention.