Abstract 16526: The Performance of the American College of Cardiology/American Heart Association 2013 Pooled Cohort Equations in Cancer Survivors

Abstract

Introduction: Cancer survivors may have greater atherosclerotic cardiovascular disease (ASCVD) risk, due in part to cardiotoxic cancer treatments. We tested how accurately the American College of Cardiology/American Heart Association 2013 pooled cohort equations (PCEs) predict 10-year ASCVD risk in cancer survivors. Objective: To estimate the calibration and discrimination of PCEs in cancer survivors as compared to non-cancer participants in the Atherosclerosis Risk in Communities (ARIC) study. Methods: We evaluated the PCEs performance among 992 cancer survivors and 3320 cancer-free participants (controls) who were free of ASCVD (defined as myocardial infarction, coronary heart disease death, or stroke) and did not use statins. Each cancer survivor was incidence-density matched with up to five controls by age (within 5 years), race, sex, and study center. Follow-up started at the index visit: the first study visit that occurred at least one year after the diagnosis date of the cancer survivor (1-17 years after diagnosis) and finished at the ASCVD event, death, or end of follow-up. PCE predictors were measured at the index visit. Calibration of PCEs predictions of 10-year ASCVD risk in cancer survivors and controls was assessed using Hosmer-Lemeshow chi-square tests. Discrimination was measured via Harrell’s C-index. Results: 54 (5%) and 224 (7%) ASCVD events were observed in 5411 and 22212 person-years among cancer survivors and controls, respectively. Median age was 69 years. 18% were Black. 51% were female. The PCEs overestimated the risk of CVD among cancer survivors as well as controls (Table 1). Discrimination was moderate in cancer survivors (C=0.73) and poorer than in controls (C=0.77). Conclusions: The PCEs overestimated ASCVD risk in cancer survivors as well as controls. Support: NHLBI, NCI, NPCR