McCracken, Celeste, Condurache, Dorina-Gabriela, Szabo, Liliana, Elghazaly, Hussein, Walter, Fiona M., Mead, Adam J., Chakraverty, Ronjon, Harvey, Nicholas C., Manisty, Charlotte H., Petersen, Steffen E., Neubauer, Stefan and Raisi-Estabragh, Zahra (2024) Predictive performance of cardiovascular risk scores in cancer survivors from the UK biobank. JACC: CardioOncology. (In Press)
Abstract
Background: cardiovascular preventive strategies are guided by risk scores with unknown validity in cancer cohorts.
Objectives: this study evaluated the predictive performance of seven established cardiovascular risk scores in cancer survivors from the UK Biobank.
Methods: the predictive performance of QRISK3, SCORE2/SCORE-OP, Framingham Risk Score, PCP-HF, CHARGE-AF, QStroke, and CHA2DS2-VASc was calculated in participants with and without a history of cancer, propensity-matched on age, sex, deprivation, health behaviours, family history, and metabolic conditions. Analyses were stratified into any cancer, breast, lung, prostate, brain/CNS, haematological, Hodgkin’s and non-Hodgkin’s lymphoma. Incident events were ascertained through health record linkage after ten years of prospective follow-up. Area under the curve (AUC), balanced accuracy, and sensitivity are reported.
Results: the analysis included 31,534 cancer survivors and 126,136 covariate-matched controls. Risk score distributions were near identical in cases and controls. Participants with any cancer had significantly higher incidence of all cardiovascular outcomes than matched controls. Performance metrics were significantly poorer for all risk scores in cancer cases than matched controls. The most notable differences were among participants with past haematological malignancies, who had significantly higher outcome rates and poorer risk score performance than their matched controls for combined heart disease, atrial fibrillation, heart failure, and stroke. Performance of risk scores for prediction of stroke in participants with brain/CNS cancer was very poor with >30% lower predictive accuracy than non-cancer controls.
Conclusion: existing cardiovascular risk scores have significantly poorer predictive accuracy in cancer survivors compared to non-cancer comparators, leading to underestimation of risk in this cohort.
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