Author + information
- Received May 19, 2020
- Revision received July 5, 2020
- Accepted July 9, 2020
- Published online September 15, 2020.
- Cilie C. van ’t Klooster, MDa@TCilie,
- Paul M. Ridker, MD, PhDb,c,
- Nancy R. Cook, PhDb,
- Joachim G.J.V. Aerts, MD, PhDd,
- Jan Westerink, MD, PhDa,
- Folkert W. Asselbergs, MD, PhDe,f,g,
- Yolanda van der Graaf, MD, PhDh,
- Frank L.J. Visseren, MD, PhDa,∗ (, )
- on behalf of the UCC-SMART Study Group
- aDepartment of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, the Netherlands
- bDivisions of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- dDepartment of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- eDepartment of Cardiology, Division Heart & Lungs, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, the Netherlands
- fInstitute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- gHealth Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
- hJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, the Netherlands
- ↵∗Address for correspondence:
Dr. Frank L.J. Visseren, Department of Vascular Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
Background Cardiovascular disease (CVD) and cancer share many common risk factors; patients with CVD also may be at risk of developing cancer.
Objectives The aim of this study was to derive and externally validate prediction models for the estimation of lifetime and 10-year risk for total, colorectal, and lung cancer in patients with established CVD.
Methods Data from patients with established CVD from the UCC-SMART cohort (N = 7,280) were used for model development, and from the CANTOS trial (N = 9,322) for model validation. Predictors were selected based on previously published cancer risk scores, clinical availability, and presence in the derivation dataset. Fine and Gray competing risk-adjusted lifetime models were developed for the outcomes total, colorectal, and lung cancer.
Results Selected predictors were age, sex, smoking, weight, height, alcohol use, antiplatelet use, diabetes, and C-reactive protein. External calibration for the 4-year risk of lung, colorectal, and total cancer was reasonable in our models, as was discrimination with C-statistics of 0.74, 0.64, and 0.63, respectively. Median predicted lifetime and 10-year risks in CANTOS were 26% (range 1% to 52%) and 13% (range 1% to 31%) for total cancer; 4% (range 0% to 13%) and 2% (range 0% to 6%) for colorectal cancer; and 5% (range 0% to 37%) and 2% (range 0% to 24%) for lung cancer.
Conclusions Lifetime and 10-year risk of total, colorectal, and lung cancer can be estimated reasonably well in patients with established CVD with readily available clinical predictors. With additional study, these tools could be used in clinical practice to further aid in the emphasis of healthy lifestyle changes and to guide thresholds for targeted diagnostics and screening.
Dr. Ridker has served as the principal investigator of CANTOS and CIRT, funded by Novartis and the National Heart, Lung, and Blood Institute (NHLBI), respectively; has received investigator-initiated research grants from Kowa, Novartis, Pfizer, AstraZeneca, NHLBI, and National Cancer Institute; has served as a consultant to Corvidia, Inflammazome, Novartis, Amgen, Merck, and Civi Bio; and is listed as co-inventor on patents related to the use of inflammatory biomarkers in cardiovascular disease and diabetes that are no longer active. Dr. Aerts has served as a consultant for Eli-Lilly, Merck Sharp & Dohme, Bristol-Myers Squibb, Boehringer Ingelheim, Amphera, AstraZeneca, Takeda, and Roche; and own stock in Amphera. Dr. Asselbergs is supported by UCL Hospitals NIHR Biomedical Research Centre. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The CANTOS trial was funded by Novartis Pharmaceuticals. The UCC-SMART study was financially supported by a grant of the University Medical Center Utrecht. The funder had no role in study design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received May 19, 2020.
- Revision received July 5, 2020.
- Accepted July 9, 2020.
- 2020 The Authors