Key result
New Zealand equations reasonably predict 5-year CVD risk in cancer survivors with ~0.70 discrimination.
Why the study?
People with cancer have an increased risk of cardiovascular disease, and the performance of New Zealand cardiovascular disease risk prediction equations in cancer survivors was unknown.
Cohort (n=14,263)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These discrepancies are likely to be trivial from a clinical perspective because most patients would still receive the recommended cardiovascular disease risk management, and the overestimation for the high-risk group would not lead to unnecessary medical treatment because all patients with a 5-year risk of cardiovascular disease of at least 15% are recommended to receive the same preventive management.”
“We found that cardiovascular disease risk prediction equations developed in a New Zealand general primary care population were reasonable clinical tools for use in survivors of cancer in New Zealand for whom the assessment of cardiovascular disease risk was considered clinically appropriate by their primary care clinician. Prediction could be improved by adding cancer-specific variables and considering competing risks. The equations can predict cardiovascular disease risk with reasonable variations from observed risk in survivors of cancer at primary care practices.”
“This study fills a gap in evidence by showing a reasonably good performance of the model in a population of patients for whom the prediction of cardiovascular disease outcomes had been neglected.”
The New Zealand cardiovascular disease risk prediction equations reasonably predict 5-year cardiovascular disease risk in cancer survivors and are reasonable clinical tools for this population.
BACKGROUND People with cancer have an increased risk of cardiovascular disease. Risk prediction equations developed in New Zealand accurately predict 5-year cardiovascular disease risk in a general primary care population in the country. We assessed the performance of these equations for survivors of cancer in New Zealand. METHODS For this validation study, patients aged 30-74 years from the PREDICT open cohort study, which was used to develop the New Zealand cardiovascular disease risk prediction equations, were included in the analysis if they had a primary diagnosis of invasive cancer at least 2 years before the date of the first cardiovascular disease risk assessment. The risk prediction equations are sex-specific and include the following predictors: age, ethnicity, socioeconomic deprivation index, family history of cardiovascular disease, smoking status, history of atrial fibrillation and diabetes, systolic blood pressure, total cholesterol to HDL cholesterol ratio, and preventive pharmacotherapy (blood-pressure-lowering, lipid-lowering, and antithrombotic drugs). Calibration was assessed by comparing the mean predicted 5-year cardiovascular disease risk, estimated using the risk prediction equations, with the observed risk across deciles of risk, for men and women, and according to the three clinical 5-year cardiovascular disease risk groups in New Zealand guidelines (<5%, 5% to <15%, and ≥15%). Discrimination was assessed by Harrell's C statistic. FINDINGS 14 263 patients were included in the study. The mean age was 61 years (SD 9) for men and 60 years (SD 8) for women, with a median follow-up of 5·8 years for men and 5·7 years for women. The observed cardiovascular disease risk was underpredicted by a maximum of 2·5% in male and 3·2% in female decile groups. When patients were grouped according to clinical risk groups, observed cardiovascular disease risk was underpredicted by less than 2% in the lower risk groups and overpredicted by 2·2% for men and 3·3% for women in the highest risk group. Harrell's C statistics were 0·67 (SE 0·01) for men and 0·73 (0·01) for women. INTERPRETATION The New Zealand cardiovascular disease risk prediction equations reasonably predicted the observed 5-year cardiovascular disease risk in survivors of cancer in the country, in whom risk prediction was considered clinically appropriate. Prediction could be improved by adding cancer-specific variables and considering competing risks. Our findings suggest that the equations are reasonable clinical tools for use in survivors of cancer in New Zealand.
No takes yet. Share an insight, caveat, or question.
Tawfiq et al. (2023) conducted a cohort in Cardiovascular disease risk in cancer survivors (n=14,263). New Zealand cardiovascular disease risk prediction equations was evaluated on Predicted vs observed 5-year cardiovascular disease risk (calibration and discrimination) (C-statistic 0.67 (men) and 0.73 (women)). The New Zealand cardiovascular disease risk prediction equations reasonably predicted 5-year CVD risk in cancer survivors, with Harrell's C statistics of 0.67 for men and 0.73 for women.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: