Risk of Cardiovascular Disease Using Framingham Risk Score in Korean Cancer Survivors

Abstract

Background: Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population.

Methods: A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007-2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases.

Results: The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer.

Conclusion: Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors.

Keywords: Cardiovascular Diseases; Neoplasms; Risk Factors; Survivors.

Figure 1. The process used to select the study population. KNHANES, Korea National Health and Nutrition Examination Survey.

Figure 2. The average 10-year risk of CVD±standard error based on the Framingham risk scores, and adjusted for age, sex, marital status, household income, education, alcohol use, physical activity, and body mass index. (A) Cancer survivors vs. the non-cancer control group. The average 10-year probability of CVD is 19.1% for the cancer survivors and 13.3% for the non-cancer controls. (B) The cancer survivors vs. the non-cancer control group, separated by sex. The average 10-year probability of CVD in men is 27% for cancer survivors and 20.8% for non-cancer controls, and in women, it is 12.5% for cancer survivors and 6.7% for non-cancer controls. CVD, cardiovascular disease. These analyses were compared using t-test.

Figure 3. The average 10-year risk of CVD±standard error based on the Framingham risk scores in relation to the cancer type, and adjusted for age, sex, marital status, household income, education, alcohol use, physical activity, and body mass index. The average 10-year probability of CVD according to the cancer type is significantly higher in hepatic, colon, lung, breast, and gastric cancer (36.7% for hepatic cancer, 32.0% for colon cancer, 31.2% for lung cancer, 17.8% for breast cancer, and 5.1% for gastric cancer) than non-cancer controls. CVD, cardiovascular disease. This analysis performed by ANCOVA analysis with post hoc Dunnett test between non-cancer subjects and survivors of cancer. ^*P-value<0.05.