Prognostic Value of the American Heart Association PREVENT Cardiovascular Disease Risk Equations in Cancer Survivorship: A NHANES Population-Based Study (2009-2018).

Background: The PREVENT (Predicting Risk of CVD Events) equations offer a contemporary tool for estimating long-term cardiovascular risk in the general population. This study evaluates the association of baseline cardiovascular risk, calculated by PREVENT equations, with all-cause and cardiovascular mortality in cancer survivors.

Methods: Using 10 years of data from the National Health and Nutrition Examination Survey (NHANES) (2009-2018), we analyzed a nationally representative cohort of US cancer survivors. Associations with outcomes were evaluated using Kaplan-Meier curves and multivariable Cox models.

Results: A total of 18 722 334 weighted records (2792 unweighted) were analyzed, recording 4 875 627 all-cause deaths (26%) and 1 025 053 cardiovascular deaths (5.5%) over a median follow-up of 9.8 years; 27.84% of cancer survivors were at high baseline cardiovascular risk with variability in baseline cardiovascular risk across different cancer sites. Colon and prostate cancer survivors had the highest prevalence of high cardiovascular risk (54% and 46%, respectively). When compared with low-risk individuals, those at high cardiovascular risk had a nearly 16-fold higher risk of all-cause mortality (adjusted hazard ratio, 15.60 [95% CI, 8.45-28.82]; P <0.001) and a 13-fold higher risk of cardiovascular mortality (adjusted hazard ratio, 12.71 [95% CI, 3.00-53.73]; P <0.001) up to a decade of follow-up. Each 5% increase in baseline cardiovascular risk was associated with higher risks of all-cause mortality (36%) and cardiovascular mortality (51%) (adjusted hazard ratio, 1.36 [95% CI, 1.30-1.42]; adjusted hazard ratio, 1.51 [95% CI, 1.33-1.72], P <0.001 for both).

Conclusions: This study highlights the usefulness of the PREVENT equations for predicting all-cause and cardiovascular mortality in cancer survivors.