Suboptimal cardiovascular risk management in cancer survivors: analysis of statin prescription patterns following coronary calcium scoring

Introduction Cancer survivors face an elevated risk of cardiovascular diseases (CVD) due to shared pathophysiological pathways, risk factors, and cardiotoxic cancer treatments. However, recent evidence suggests that CVD management in this vulnerable population may be suboptimal. Purpose To evaluate the implementation of recommended treatment plans for cancer survivors with positive coronary artery calcium (CAC) scoring. Methods Asymptomatic cancer survivors underwent CVD risk assessment using the pooled cohort equation (PCE). Those with intermediate risk (5%-20%) were referred for computed tomography CAC scoring. Results and statin prescription recommendations for participants with positive CAC scores were communicated to both participants and their general physicians (GPs). Results Among 435 cancer survivors who completed PCE risk assessment (median 9.25% [IQR 7.2%-13.2%]), 210 (48.3%) were classified as intermediate risk. Of these, 152 underwent CAC scoring (median 3.5 [IQR 0-61.3]). CAC score distribution was: 0 (n=67, 45%), 1-100 (n=62, 40.8%), 101-400 (n=17, 11.2%), and >401 (n=5, 4%). In the CAC 1-100 group, 17 participants did not receive recommended statin treatment, primarily due to GPs deeming it unnecessary (n=12) or patient reluctance (n=5). Statin prescription rates increased with CAC severity: 101-400 (67%) and >400 (75%). Stratifying the cohort into obese individuals (BMI >30kg/m2, n=45, 29.6%) or those who are on antihypertensive medication (n=57, 37.5%), no significant difference was identified in statin prescription rate (p=0.595 and p=0.330, respectively). Notably, some GPs opted for lifestyle modifications, as well as cholesterol and blood pressure monitoring, over statin prescription, even in cases of high CAC scores, citing absence of symptoms and normal cholesterol levels. Conclusion Cancer survivors with documented coronary calcification are receiving suboptimal cardiovascular risk management, predominantly due to asymptomatic presentation and statin-related misconceptions. Future research should investigate GPs' understanding of CVD risk management in cancer survivors, particularly regarding the clinical significance of coronary calcification.