Abstract EP68: Can A Single Model For General Population Predict Cardiovascular Events In Cancer Survivors?

Abstract

Introduction: No specific guideline exists for the primary prevention of cardiovascular disease (CVD) in cancer survivors. We hypothesized that CVD risk and its association with risk factors are comparable between cancer survivors and the general population, such that they may share currently available risk scores (e.g., Pooled Cohort Equation; PCE) for initial risk discussion. Methods: We studied 59 445 cancer survivors (≥5 years from diagnosis) and 59 445 age/sex-matched non-cancer controls aged 40-79 years (51.6% female) and free of CVD among participants of 2009 Korean National Health Insurance health screening. We calculated 10-year cumulative incidence of CVD events (composite of myocardial infarction, stroke, or cardiovascular death) and hazard ratios for traditional CVD risk factors in cancer survivors vs. non-cancer controls. We then evaluated discrimination and calibration of a previously-derived, general Korean population-based CVD risk model (having similar predictors as the PCE) applied to cancer survivors. Results: During a median follow-up of 10.3 years, 6,809 CVD events occurred. Multivariable-adjusted 10-year cumulative CVD incidence was 2.8% (2.7-3.0) among cancer survivors and 3.0% (2.0-3.2) among non-cancer controls (Figure A). Associations of traditional risk factors with CVD events were similar between cancer survivors and controls (Figure B). Results were consistent when stratified by sex and age. A CVD risk model, previously derived from the general Korean population similarly as the PCE, showed good discrimination (C-index, 0.747) and calibration (Figure C) when applied to cancer survivors. By cancer subtype, some cancers were associated with higher or lower CVD risk than controls (Figure D). Conclusions: CVD risk and associations with predictors were similar between cancer survivors and non-cancer individuals. Pre-existing models for general population may perform well in overall cancer survivors, although subtype-specific recalibration may be desirable for some cancers.