Framingham Risk Score Predicts New-Onset Cancer and Heart Failure

Overview

This study demonstrates that higher Framingham risk score (FRS) tertiles are significantly associated with increased incidence of both cancer and heart failure (HF) in two large cohorts. The findings suggest that FRS, traditionally used for cardiovascular risk, may have broader clinical utility in predicting cancer risk as well.

Background

Cardiovascular disease and cancer are leading causes of death worldwide and often coexist, with overlapping risk factors and pathophysiological mechanisms. Heart failure patients have an increased risk of cancer, partly due to cardiotoxic cancer treatments, while cancer survivors are also at risk of HF. The Framingham risk score (FRS) is a validated tool for estimating 10-year atherosclerotic cardiovascular disease risk but its predictive value for cancer and HF has been unclear. Evaluating these outcomes together may improve risk stratification and preventive strategies.

Data Highlights

Key Findings

• Participants in the highest FRS tertile had over twice the hazard of developing new-onset cancer compared to those in the lowest tertile (sHR ~2.3 in PREVEND, ~2.0 in UK Biobank).
• Highest FRS tertile was associated with a markedly increased hazard of new-onset heart failure (sHR ~10.1 in PREVEND, ~6.0 in UK Biobank).
• Higher FRS tertiles correlated with worse overall survival (log-rank P < 0.001).
• The association between FRS and incident cancer or HF remained significant after adjusting for kidney function markers and competing risk of death.
• Findings were validated across two large, ethnically diverse population cohorts, supporting generalizability.

Clinical Implications

The Framingham risk score can be used beyond cardiovascular disease risk stratification to identify individuals at elevated risk for both cancer and heart failure. This integrated risk assessment may prompt earlier lifestyle interventions, optimized management of cardiovascular risk factors, and more vigilant surveillance for cancer and HF. Such an approach supports a more holistic strategy in cardio-oncology and preventive medicine.

Conclusion

The FRS is a valuable predictor of new-onset cancer and heart failure, highlighting its potential role in integrated risk assessment. Incorporating FRS into clinical practice may enhance early identification and prevention of these major diseases.

References

1. van der Meer et al. 2024 -- Association of Framingham Risk Score with the Onset of Cancer and Heart Failure