Cancer patients aged ≥40 years without established CVD or diabetes mellitus
Care Setting
Cardio-oncology clinical settings and long-term follow-up care
Key Highlights
SCORE2 and SCORE2-OP models initially underestimate 10-year CVD risk in cancer patients.
Recalibration of SCORE2 improves risk prediction accuracy and model calibration.
16% of cancer patients experienced a CVD event during a median 8.8-year follow-up.
Guideline-Based Recommendations
Diagnosis
Use SCORE2 and SCORE2-OP models for cardiovascular risk stratification in cancer patients as recommended by 2022 ESC cardio-oncology guidelines.
Consider the HFA-ICOS four-category risk stratification tool alongside SCORE2 models.
Management
Apply recalibrated SCORE2 for targeted preventive interventions including lifestyle and pharmacologic measures.
Enhance follow-up during and after cancer treatment to monitor and manage CVD risk.
Monitoring & Follow-up
Regular cardiovascular risk assessment during cancer survivorship to identify high-risk patients.
Monitor for cardiotoxicity and changes in cardiac biomarkers and function, although these are not included in SCORE2 models.
Risks
Cancer and its treatments increase CVD risk beyond traditional factors included in SCORE2 models.
High competing risk of non-CVD mortality in cancer patients may affect risk prediction accuracy.
Patient & Prescribing Data
Cancer patients without prior CVD or diabetes, aged ≥40 years, predominantly gastrointestinal, prostate, and breast cancers
Recalibrated SCORE2 model may guide cardiovascular preventive treatment decisions before and after cancer therapy; further validation in cancer subgroups is needed.
Clinical Best Practices
Exclude patients with established CVD or diabetes mellitus when applying SCORE2 and SCORE2-OP models.
Recalibrate SCORE2 risk estimates using population-specific adjustment factors to improve accuracy in cancer patients.
Integrate cardiovascular risk stratification into routine cancer care to enable early intervention.
Recognize limitations of existing models and the need for further validation in diverse cancer subgroups.
by Mari Nordbø Gynnild, Joris Holtrop, Steven H J Hageman, Victoria Vinje, Jannick A N Dorresteijn, Frank L J Visseren, Espen Holte, Håvard Dalen, Torgeir Wethal, Torbjørn Omland
