The Framingham risk score underestimates the risk of cardiovascular events in the HER2-positive breast cancer population

W. Law, C. Johnson, M. Rushton, S. Dent

Abstract


Introduction

Patients with breast cancer (bca) who overexpress her2 (the human epidermal growth factor receptor 2) are at risk for cardiotoxicity when treated with anthracycline-based chemotherapy and her2-targeted agents. The Framingham risk score (frs) is a validated tool that stratifies patients into high-, intermediate-, or low-risk groups and calculates their 10-year risk of developing cardiovascular disease (cvd) based on past medical history, systolic blood pressure, and measurement of serum lipids. We retrospectively analyzed patients with her2-positive bca to determine whether the frs predicts adverse cardiovascular (CV) events or cardiotoxicity in patients treated using anthracyclines or her2-targeted therapy, or both.

Methods

The frs was determined for patients with bca referred to The Ottawa Hospital Cardiology–Oncology Clinic from October 2008 to August 2014. The patients were stratified into high (≥20%), intermediate (10%–20%), and low (<10%) 10-year cv risk groups. Primary outcomes included cvd-related hospitalizations and deaths, and cardiotoxicity [drop in left ventricular ejection fraction (lvef) of >10% to a lvef ≤50%].

Results

Of the 152 patients included in the analysis (median follow-up: 40.7 months; range: 3.5–263 months), 47 (31%) were classified as high risk; 36 (24%), as intermediate risk; and 69 (45%), as low-risk. The number of cvd-related hospitalizations and deaths was 22, for an overall prevalence of 14%, with significantly more events occurring in high-risk than in low-risk patients (odds ratio: 4.18; 95% confidence limits: 1.47, 11.89). The frs predicted a 10-year risk of any cv event of 11.2% and underestimated the actual rate of cv events in the entire cohort. High frs was not associated with cardiotoxicity (p = 0.82).

Conclusions

In a population of patients with her2-positive bca referred to a cardiology–oncology clinic, the frs does not accurately predict the risk of cv events or cardiotoxicity.


Keywords


Cardio-oncology; breast cancer; her2; trastuzumab; cardiotoxicity; Framingham risk score

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DOI: http://dx.doi.org/10.3747/co.24.3684






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)