Framingham risk score associates with incident cancer and heart failure

The Framingham Risk Score (FRS) combines several cardiovascular (CV) and cancer risk factors including age, obesity and smoking and has been a longstanding tool for the risk stratification of CV disease (CVD). However, its application in cancer and heart failure (HF) risk stratification remains to be evaluated.

To demonstrate that FRS may be used as a tool for risk stratification of both new-onset cancer and HF.

We performed a post-hoc analysis using data from the PREVEND study to examine the relationship between tertiles of FRS at baseline and the incidence of new-onset cancer and HF. Fine-Gray competing risks regression models were employed to estimate subdistribution hazard ratios (sHRs) for each outcome, adjusting for sex, age at baseline, and including heart failure (in the cancer model) or cancer (in the heart failure model) with all-cause mortality as a competing risk. Time-to-event was defined from baseline to the earliest occurrence of cancer or HF diagnosis, death or end of follow-up. We performed survival analyses with the log-rank test and visualized this with a Kaplan-Meier curve. Fisher’s exact test was used to assess the association between FRS tertiles and subsequent events (i.e., cancer after heart failure or heart failure after cancer).

We included a total of 7317 participants free of CVD (mean age 48±12 years, 53% female). Of these, 977 experienced new-onset cancer (follow-up 18 years) and 522 new-onset HF (follow-up 25 years). In the multivariate Fine-Gray regression, individuals in the third tertile of the FRS had a significantly higher hazard for both new-onset cancer (sHR 1.39, 95% CI 1.06–1.81, p=0.016) and new-onset HF (sHR 7.83, 95% CI 4.73–12.97, p<0.001) compared to those in the first tertile. Furthermore, participants in the highest FRS tertile exhibited the poorest survival (log-rank p<0.001) and were more likely to experience a second event (i.e., either HF after cancer or cancer after HF; p<0.001 for both).

The FRS is associated with both new-onset cancer and even more so with HF for those in the highest tertile, and this association persists for a subsequent event. These findings highlight the potential utility of the FRS beyond cardiovascular risk stratification, warranting further research into its broader clinical applications in the general population.