Mari Nordbø Gynnild, Joris Holtrop, Steven H J Hageman, Victoria Vinje, Jannick A N Dorresteijn, Frank L J Visseren, Espen Holte, Håvard Dalen, Torgeir Wethal, Torbjørn Omland
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引用次数: 0
Abstract
Background: The 2022 ESC Cardio-oncology guidelines recommend cardiovascular disease (CVD) risk stratification for cancer patients and suggest using SCORE2 and SCORE2-OP. However, these models have not been validated or specifically adapted for cancer populations.
Aim: Refinement of SCORE2 and SCORE2-OP models to accurately predict 10-year fatal and non-fatal CVD risk in cancer patients.
Methods: We included 1,622 patients from the HUNT3 study (2006-2008) who were diagnosed with cancer within 4 years after their enrollment and followed until 2023 linked to national registries. The primary outcome was a composite of myocardial infarction (MI), stroke, or CVD mortality. Model performance was assessed using Harrel's C-statistic and calibration curves. Both models were recalibrated by applying a multiplicative adjustment factor based on expected-observed (E/O) ratios.
Results: The most prevalent cancers were gastrointestinal (23%), prostate (17%), and breast (14%). Mean age was 65.2 years, 52% were female. During a median follow-up of 8.8 years [interquartile range 1.9-12.6], 252 CVD events (39% MI, 36% stroke, 25% CVD deaths) and 708 non-CVD deaths occurred. SCORE2 initially underestimated CVD risk (E/O ratio for men and women: 0.91 and 0.63, respectively) but showed adequate agreement after recalibration. C-statistics for SCORE2 was 0.693 (95% confidence interval (CI) 0.643-0.743), and 0.730 (95% CI 0.676-0.784) after excluding those not surviving the first 2 years. For SCORE2-OP, the C-statistics were 0.586 (95% CI 0.529-0.643) and 0.648 (95% CI 0.577-0.720).
Conclusions: SCORE2 underestimated CVD risk in cancer patients. After recalibration, the model may serve as a valuable tool for risk stratification in cancer patients.
期刊介绍:
European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.