TY - JOUR
T1 - Performance of the pooled cohort equations in cancer survivors
T2 - the Atherosclerosis Risk in Communities study
AU - Polter, Elizabeth J.
AU - Blaes, Anne
AU - Wolfson, Julian
AU - Lutsey, Pamela L.
AU - Florido, Roberta
AU - Joshu, Corinne E.
AU - Guha, Avirup
AU - Platz, Elizabeth A.
AU - Prizment, Anna
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023.
PY - 2024/2
Y1 - 2024/2
N2 - Background: Cancer survivors may have elevated atherosclerotic cardiovascular disease (ASCVD) risk. Therefore, 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. Objectives: To estimate the calibration and discrimination of the PCEs in cancer survivors compared to non-cancer participants in the Atherosclerosis Risk in Communities (ARIC) study. Methods: We evaluated the PCEs’ performance among 1244 cancer survivors and 3849 cancer-free participants who were free of ASCVD at the start of follow-up. Each cancer survivor was incidence-density matched with up to five controls by age, race, sex, and study center. Follow-up began at the first study visit at least 1 year after the diagnosis date of the cancer survivor and finished at the ASCVD event, death, or end of follow-up. Calibration and discrimination were assessed and compared between cancer survivors and cancer-free participants. Results: Cancer survivors had higher PCE-predicted risk, at 26.1%, compared with 23.1% for cancer-free participants. There were 110 ASCVD events in cancer survivors and 332 ASCVD events in cancer-free participants. The PCEs overestimated ASCVD risk in cancer survivors and cancer-free participants by 45.6% and 47.4%, respectively, with poor discrimination in both groups (C-statistic for cancer survivors = 0.623; for cancer-free participants, C = 0.671). Conclusions: The PCEs overestimated ASCVD risk in all participants. The performance of the PCEs was similar in cancer survivors and cancer-free participants. Implications for Cancer Survivors: Our findings suggest that ASCVD risk prediction tools tailored to survivors of adult cancers may not be needed.
AB - Background: Cancer survivors may have elevated atherosclerotic cardiovascular disease (ASCVD) risk. Therefore, 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. Objectives: To estimate the calibration and discrimination of the PCEs in cancer survivors compared to non-cancer participants in the Atherosclerosis Risk in Communities (ARIC) study. Methods: We evaluated the PCEs’ performance among 1244 cancer survivors and 3849 cancer-free participants who were free of ASCVD at the start of follow-up. Each cancer survivor was incidence-density matched with up to five controls by age, race, sex, and study center. Follow-up began at the first study visit at least 1 year after the diagnosis date of the cancer survivor and finished at the ASCVD event, death, or end of follow-up. Calibration and discrimination were assessed and compared between cancer survivors and cancer-free participants. Results: Cancer survivors had higher PCE-predicted risk, at 26.1%, compared with 23.1% for cancer-free participants. There were 110 ASCVD events in cancer survivors and 332 ASCVD events in cancer-free participants. The PCEs overestimated ASCVD risk in cancer survivors and cancer-free participants by 45.6% and 47.4%, respectively, with poor discrimination in both groups (C-statistic for cancer survivors = 0.623; for cancer-free participants, C = 0.671). Conclusions: The PCEs overestimated ASCVD risk in all participants. The performance of the PCEs was similar in cancer survivors and cancer-free participants. Implications for Cancer Survivors: Our findings suggest that ASCVD risk prediction tools tailored to survivors of adult cancers may not be needed.
KW - Cancer
KW - Cardio-oncology
KW - Cardiovascular disease
KW - Risk prediction
KW - Survivorship
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U2 - 10.1007/s11764-023-01379-0
DO - 10.1007/s11764-023-01379-0
M3 - Article
C2 - 37140677
AN - SCOPUS:85157967369
SN - 1932-2259
VL - 18
SP - 124
EP - 134
JO - Journal of Cancer Survivorship
JF - Journal of Cancer Survivorship
IS - 1
ER -