Key result
A 1-year cancer survivorship variable met the threshold for inclusion in the QRISK3 cardiovascular risk model for males (HR 1.16) but not females (HR 1.07).
Why the study?
Cardiovascular risks are raised in cancer survivors, but cancer history is not included in cardiovascular risk scores that inform preventive decisions.
Does the inclusion of cancer history improve the prediction of coronary heart and cerebrovascular disease in cardiovascular risk scores (QRISK3) among adults without prior cardiovascular disease?
Cohort (n=494,967)
Yes
Does the inclusion of cancer history improve the prediction of coronary heart and cerebrovascular disease in cardiovascular risk scores (QRISK3) among adults without prior cardiovascular disease?
Effect estimate: HR 1.16 (95% CI 1.11 to 1.20)
p-value: p=<0.001
Cancer history, particularly haematological cancer, significantly increases 10-year cardiovascular risk and meets the statistical thresholds for inclusion in future iterations of cardiovascular risk prediction models like QRISK3.
Supports incorporating cancer history into male CV risk scores; extends QRISK3 but should not yet change practice without validation.
Background Cardiovascular risks are raised in cancer survivors but cancer history is not included in cardiovascular risk scores that inform preventive decisions. Aim To assess whether cancer diagnosis should be included in cardiovascular risk scores. Design and setting Cohort study using data from English general practices linked to hospital, cancer registration, and death registration data from 1990 to 2015. Method Adults alive 1 year after a first cancer diagnosis and age, sex, general practice, and calendar- time matched cancer-free individuals were included. Individuals with <2 years of follow-up before index, recent statin prescriptions, or pre-existing coronary heart or cerebrovascular disease were excluded. Cox proportional hazard models used to develop QRISK3 scores were replicated with added cancer history variables. Whether independent hazard ratios for these variables met thresholds for inclusion in QRISK3 (>10% relative difference with P <0.01) was assessed. Results In total, 81 420 cancer survivors and 413 547 cancer-free individuals were followed for a median 5.2 years (interquartile range [IQR] 2.8– 9.1) and 6.3 years (IQR 3.5–10.2), respectively. Including a 1-year cancer survivorship variable in a QRISK3-based model met the threshold for inclusion for males (independent hazard ratio [iHR] 1.16, 95% confidence interval [CI] = 1.11 to 1.20, P <0.001) but not females (iHR 1.07, 95% CI = 1.01 to 1.14, P = 0.02). When including cancer type, the threshold was met for both sexes with history of haematological cancer (males: iHR 1.27, 95% CI = 1.16 to 1.40, P <0.001; females: iHR 1.59, 95% CI = 1.32 to 1.91, P <0.001) and for males but not females with history of solid cancers (males: iHR 1.13, 95% CI = 1.08 to 1.18, P <0.001; females: iHR 1.04, 95% CI = 0.98 to 1.10, P = 0.19). Conclusion Developers should consider including cancer history variables in future cardiovascular risk models.
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Strongman et al. (2022) conducted a cohort in Cancer survivorship (cardiovascular risk) (n=494,967). 1-year cancer survivorship (history of cancer) vs. Cancer-free individuals was evaluated on Independent hazard ratio for coronary heart and cerebrovascular disease to meet QRISK3 inclusion threshold (HR 1.16, 95% CI 1.11 to 1.20, p=<0.001). A 1-year cancer survivorship variable met the threshold for inclusion in the QRISK3 cardiovascular risk model for males (HR 1.16) but not females (HR 1.07).
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