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
{"title":"系统冠状动脉风险评估2 （SCORE2）和SCORE2-老年人癌症患者的外部验证","authors":"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","doi":"10.1093/eurjpc/zwaf356","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>Refinement of SCORE2 and SCORE2-OP models to accurately predict 10-year fatal and non-fatal CVD risk in cancer patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>SCORE2 underestimated CVD risk in cancer patients. After recalibration, the model may serve as a valuable tool for risk stratification in cancer patients.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":""},"PeriodicalIF":8.4000,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"External validation of the Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons in cancer patients.\",\"authors\":\"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\",\"doi\":\"10.1093/eurjpc/zwaf356\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>Refinement of SCORE2 and SCORE2-OP models to accurately predict 10-year fatal and non-fatal CVD risk in cancer patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>SCORE2 underestimated CVD risk in cancer patients. After recalibration, the model may serve as a valuable tool for risk stratification in cancer patients.</p>\",\"PeriodicalId\":12051,\"journal\":{\"name\":\"European journal of preventive cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.4000,\"publicationDate\":\"2025-06-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of preventive cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/eurjpc/zwaf356\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of preventive cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/eurjpc/zwaf356","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：2022年ESC心血管肿瘤学指南推荐对癌症患者进行心血管疾病（CVD）风险分层，并建议使用SCORE2和SCORE2- op。然而，这些模型尚未得到验证或专门适用于癌症人群。目的：改进SCORE2和SCORE2- op模型，准确预测癌症患者10年致死性和非致死性心血管疾病风险。方法：我们纳入了来自HUNT3研究（2006-2008）的1,622例患者，这些患者在入组后4年内被诊断为癌症，并随访至2023年，与国家登记处相关联。主要结局是心肌梗死（MI）、中风或心血管疾病死亡率的综合结果。采用Harrel’s c统计量和校准曲线对模型性能进行评估。通过应用基于预期观测（E/O）比率的乘法调整因子，对两个模型进行了重新校准。结果：最常见的癌症是胃肠道（23%）、前列腺（17%）和乳腺癌（14%）。平均年龄65.2岁，女性占52%。在中位随访8.8年（四分位数范围1.9-12.6）期间，共发生252例心血管疾病事件（39%心肌梗死，36%卒中，25%心血管疾病死亡）和708例非心血管疾病死亡。SCORE2最初低估了心血管疾病的风险（男性和女性的E/O比分别为0.91和0.63），但在重新校准后显示出足够的一致性。排除前2年未存活患者后，SCORE2的c -统计量为0.693(95%可信区间（CI） 0.643-0.743), 0.730 （95% CI 0.676-0.784）。SCORE2-OP的c统计量分别为0.586 （95% CI 0.529-0.643）和0.648 （95% CI 0.577-0.720）。结论：SCORE2低估了癌症患者的心血管疾病风险。重新校准后，该模型可以作为癌症患者风险分层的有价值的工具。
External validation of the Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons in cancer patients.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
