The Framingham Risk Score Underestimates the Risk of Cardiovascular Events in the HER2-Positive Breast Cancer Population

Law, Wyanne; Johnson, Christopher; Rushton, Moira; Dent, Susan

doi:10.3747/co.24.3684

Cited by 34 publications

(17 citation statements)

References 21 publications

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“…Most prior studies on CVD after EBC have focused on older women, specific treatments, or specific types of CVD, limiting direct comparisons to our data (3,5,11,12,32,49). It was recently reported that the Framingham risk score underestimates CVD risk in HER2-positive breast cancer (50). This may reflect the higher CVD rate in cardiotoxin-treated patients compared with cancer-free women.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study

Abdel‐Qadir¹,

Thavendiranathan²,

Austin³

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background Data are limited regarding the risk of heart failure (HF) requiring hospital-based care after early stage breast cancer (EBC) and its relationship to other types of cardiovascular disease (CVD). Methods We conducted a population-based, retrospective cohort study of EBC patients (diagnosed April 1, 2005–March 31, 2015) matched 1:3 on birth-year to cancer-free control subjects. We identified hospitalizations and emergency department visits for CVD through March 31, 2017. We used cumulative incidence function curves to estimate CVD incidence and cause-specific regression models to compare CVD rates between cohorts. All statistical tests were two-sided. Results We identified 78 318 EBC patients and 234 954 control subjects. The 10-year incidence of CVD hospitalization was 10.8% (95% confidence interval [CI] = 10.5% to 11.1%) after EBC and 9.1% (95% CI = 8.9% to 9.2%) in control subjects. Ischemic heart disease was the most common reason for CVD hospitalization after EBC. After regression adjustment, the relative rates compared with control subjects remained statistically significantly elevated for HF (hazard ratio [HR] = 1.21, 95% CI = 1.14 to 1.29, P < .001), arrhythmias (HR = 1.31, 95% CI = 1.23 to 1.39, P < .001), and cerebrovascular disease (HR 1.10, 95% CI = 1.04 to 1.17, P = .002) hospitalizations. It was rare for HF hospital presentations (2.9% of cases) to occur in EBC patients without recognized risk factors (age >60 years, hypertension, diabetes, prior CVD). Anthracycline and/or trastuzumab were used in 28 950 EBC patients; they were younger than the overall cohort with lower absolute rates of CVD, hypertension, and diabetes. However, they had higher relative rates of CVD in comparison with age-matched control subjects. Conclusions Atherosclerotic diagnoses, rather than HF, were the most common reasons for CVD hospitalization after EBC. HF hospital presentations were often preceded by risk factors other than chemotherapy, suggesting potential opportunities for prevention.

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Section: Discussionmentioning

confidence: 99%

The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study

Abdel‐Qadir¹,

Thavendiranathan²,

Austin³

et al. 2019

JNCI: Journal of the National Cancer Institute

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“…In our analyses, we used the non-laboratory-based Framingham risk measure, an estimate of 10-year general CVD risk that integrates information on age, diabetes, smoking, BMI, and treated and untreated systolic blood pressure, to compare changes in risk according to breast cancer status. Though this risk score has not been validated among women with breast cancer, and may underestimate the absolute risk in this population since it does not incorporate information on a woman’s history of cardiotoxic cancer treatments, 14 it is useful as a summary measure of traditional risk factors that may increase CVD risk in both cancer and noncancer groups. To our knowledge, ours is the first study among breast cancer survivors to utilize the non-laboratory-based version of the Framingham risk score, which, unlike the full Framingham risk model, uses BMI rather than lipids in the estimation of CVD risk.…”

Section: Discussionmentioning

confidence: 99%

Changes in cardiovascular disease risk and risk factors among women with and without breast cancer

Anderson

Nichols

Deal

et al. 2018

Cancer

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Background: Cardiovascular disease (CVD) risk is an important health concern among breast cancer survivors. However, few studies have examined whether trajectories of CVD risk and major risk factors are worse among women with a breast cancer diagnosis than those without. Methods: We compared changes in weight, body mass index (BMI), waist circumference, systolic blood pressure, and 10-year CVD risk between women with (N=813) and without (N=1049) an incident breast cancer diagnosis while enrolled in the Sister Study cohort. Blood pressure and adiposity measures were collected by trained examiners at an enrollment visit (≥1 year before breast cancer diagnosis) and a second home visit 4–11 years later (≥1 year after breast cancer diagnosis). The non-laboratory-based Framingham risk score, a measure of 10-year general CVD risk, was calculated at both the enrollment and second visits. All analyses were stratified by menopausal status at enrollment. Results: Women who were premenopausal at enrollment experienced moderate increases in weight, waist circumference, systolic blood pressure, and CVD risk over the study period. Those who were postmenopausal at enrollment had little change in weight, but increases in waist circumference, systolic blood pressure, and CVD risk. In both groups, changes over time did not differ significantly according to breast cancer status. Neither chemotherapy nor endocrine therapy were associated with greater increases in CVD risk or risk factors. Conclusions: In our cohort, changes over time in CVD risk, adiposity measures, and blood pressure were similar between women who developed an incident breast cancer and those who did not.

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“…For example, a number of risk scores are available for the prediction of coronary heart disease such as the Framingham risk score (FRS) [ 20 , 21 ], World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts [ 38 ], American College of Cardiology/American Heart Association (ACC/AHA) pooled cohort equations [ 36 ], the third Joint British Societies’ risk calculator (RiskJBS) [ 37 ], and the Systematic Coronary Risk Evaluation (SCORE) [ 39 ]. While these are validated and widely used tools for the prediction of coronary heart disease, studies suggest that they tend to underestimate an individual’s actual risk, thereby potentially delaying initiation of an appropriate intervention such as lifestyle modification [ 35 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Risk Scores and Lifestyle Behavioursmentioning

confidence: 99%

The Potential Benefit of Monitoring Oxidative Stress and Inflammation in the Prevention of Non-Communicable Diseases (NCDs)

Seyedsadjadi

Grant

2020

Antioxidants

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The significant increase in worldwide morbidity and mortality from non-communicable diseases (NCDs) indicates that the efficacy of existing strategies addressing this crisis may need improvement. Early identification of the metabolic irregularities associated with the disease process may be a key to developing early intervention strategies. Unhealthy lifestyle behaviours are well established drivers of the development of several NCDs, but the impact of such behaviours on health can vary considerably between individuals. How can it be determined if an individual’s unique set of lifestyle behaviours is producing disease? Accumulating evidence suggests that lifestyle-associated activation of oxidative and inflammatory processes is primary driver of the cell and tissue damage which underpins the development of NCDs. However, the benefit of monitoring subclinical inflammation and oxidative activity has not yet been established. After reviewing relevant studies in this context, we suggest that quantification of oxidative stress and inflammatory biomarkers during the disease-free prodromal stage of NCD development may have clinical relevance as a timely indicator of the presence of subclinical metabolic changes, in the individual, portending the development of disease. Monitoring markers of oxidative and inflammatory activity may therefore enable earlier and more efficient strategies to both prevent NCD development and/or monitor the effectiveness of treatment.

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The Framingham Risk Score Underestimates the Risk of Cardiovascular Events in the HER2-Positive Breast Cancer Population

Abstract: IntroductionPatients with breast cancer (bca) who overexpress her2 (the human epidermal growth factor receptor

Cited by 34 publications

References 21 publications

The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study

The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study

Changes in cardiovascular disease risk and risk factors among women with and without breast cancer

The Potential Benefit of Monitoring Oxidative Stress and Inflammation in the Prevention of Non-Communicable Diseases (NCDs)

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