Reassessing Cardiovascular Risk Assessment in Cancer Survivors
Overview
Cancer survivors face an elevated risk of cardiovascular (CV) disease, often underestimated by conventional risk tools. The study by Gynnild et al. demonstrates that recalibration of the SCORE2 risk prediction tool can improve CV risk estimation in cancer patients, though with moderate discrimination and notable sex disparities.
Background
Cardiovascular disease is a leading non-cancer cause of death among cancer survivors, sometimes surpassing cancer mortality early after diagnosis. Elevated CV risk in this population arises from traditional risk factors and cancer-specific variables such as pro-inflammatory states and cardiotoxic therapies. While guidelines exist for monitoring cardiotoxicity during active cancer treatment, long-term CV risk assessment in survivors lacks specific guidance. Existing general CV risk tools often underestimate risk in cancer survivors as they do not incorporate cancer-related factors.
Data Highlights
Parameter
Value
Sample size
1622 cancer patients
Median time from enrolment to cancer diagnosis
2.8 years
Median follow-up duration
8.8 years
CV event rate <70 years
8.8%
CV event rate >70 years
20.2%
SCORE2 E/O ratio females
0.63 (underestimation)
SCORE2 E/O ratio males
0.91
Post-recalibration C-statistic overall
0.693 (95% CI 0.643–0.743)
Post-recalibration C-statistic males
0.633
Key Findings
Cancer survivors have increased CV risk often underestimated by SCORE2, especially in females (E/O ratio 0.63).
Recalibration of SCORE2 improved concordance between predicted and observed CV events, with moderate discrimination (C-statistic ~0.69 overall).
Discrimination performance varied by sex, with lower C-statistic in males after recalibration (0.633).
SCORE2 performed better with longer time from cancer diagnosis and in subgroups such as non-metastatic disease and survivors beyond 2 years.
Significant heterogeneity in CV risk and SCORE2 performance exists across cancer types and sexes.
Current recalibration findings are hypothesis-generating and require external validation and larger sample sizes.
Clinical Implications
Clinicians should be aware that conventional CV risk tools like SCORE2 may underestimate risk in cancer survivors, particularly females. While recalibration shows promise to improve risk prediction, it is not yet ready for routine clinical use. Careful individualized CV risk assessment and monitoring remain essential, especially in the early years post-cancer diagnosis.
Conclusion
The study highlights the limitations of existing CV risk tools in cancer survivors and proposes recalibration as a potential interim strategy. Further research and external validation are needed to develop robust, cancer-specific CV risk prediction models.
Patients are mining Reddit and TikTok for symptom intel while you're not — and a small study calls it epistemic injustice. Different knowledge, mutually unrecognized. Maybe ask where they've been reading before you wave it off as anecdote.
