Published 2024
| Version v1
Publication
Biomarker-enhanced cardiovascular risk prediction in patients with cancer: a prospective cohort study
Creators
- Kraler, Simon
- Liberale, Luca
- Nopp, Stephan
- Englisch, Cornelia
- Grilz, Ella
- Lapikova-Bryhinska, Tetiana
- Akhmedov, Alexander
- Carbone, Federico
- Ramoni, Davide
- Tirandi, Amedeo
- Scuricini, Alessandro
- Isoppo, Simone
- Tortorella, Curzia
- La Rosa, Federica
- Michelauz, Cristina
- Frè, Federica
- Gavoci, Aurora
- Lisa, Anna
- Suter, Thomas M
- von Eckardstein, Arnold
- Wenzl, Florian A
- Pabinger, Ingrid
- Lüscher, Thomas F
- Montecucco, Fabrizio
- Ay, Cihan
- Moik, Florian
Contributors
Others:
- Kraler, Simon
- Liberale, Luca
- Nopp, Stephan
- Englisch, Cornelia
- Grilz, Ella
- Lapikova-Bryhinska, Tetiana
- Akhmedov, Alexander
- Carbone, Federico
- Ramoni, Davide
- Tirandi, Amedeo
- Scuricini, Alessandro
- Isoppo, Simone
- Tortorella, Curzia
- La Rosa, Federica
- Michelauz, Cristina
- Frè, Federica
- Gavoci, Aurora
- Lisa, Anna
- Suter, Thomas M
- von Eckardstein, Arnold
- Wenzl, Florian A
- Pabinger, Ingrid
- Lüscher, Thomas F
- Montecucco, Fabrizio
- Ay, Cihan
- Moik, Florian
Description
Background: Continuously improving cancer-specific survival puts a growing proportion of cancer patients at risk of major adverse cardiovascular events (MACE), but tailored tools for cardiovascular risk prediction remain unavailable. Objectives: To assess a broad panel of cardiovascular biomarkers and risk factors for the prediction of MACE and cardiovascular death in cancer patients. Methods: In total, 2192 patients with newly diagnosed or recurrent cancer were followed prospectively for the occurrence of 2-year MACE and 5-year cardiovascular death. Univariable and multivariable risk models were fit to assess independent associations of cardiovascular risk factors and biomarkers with adverse outcomes, and a risk score was developed. Results: Traditional cardiovascular risk factors and selected cancer types were linked to higher MACE risk. While levels of Lp(a), CRP, and GDF-15 did not associate with MACE, levels of ICAM-1, P-/E-/L-selectins, and NT-proBNP were independently linked to 2-year MACE risk. A clinical risk score was derived, assigning +1 point for male sex, smoking, and age of ≥60 years and +2 points for atherosclerotic disease, yielding a bootstrapped C-statistic of 0.76 (95% CI: 0.71-0.81) for the prediction of 2-year MACE. Implementation of biomarker data conferred improved performance (0.83, 95% CI: 0.78-0.88), with a simplified model showing similar performance (0.80, 95% CI: 0.74-0.86). The biomarker-enhanced and simplified prediction models achieved a C-statistic of 0.82 (95% CI: 0.71-0.93) and 0.74 (95% CI: 0.64-0.83) for the prediction of 5-year cardiovascular death. Conclusion: Biomarker-enhanced risk prediction strategies allow the identification of cancer patients at high risk of MACE and cardiovascular death. While external validation studies are ongoing, this first-of-its-kind risk score may provide the basis for personalized cardiovascular risk assessment across cancer entities.
Additional details
Identifiers
- URL
- https://hdl.handle.net/11567/1205455
- URN
- urn:oai:iris.unige.it:11567/1205455
Origin repository
- Origin repository
- UNIGE