Development and Validation of a Risk Score Model for Predicting the Cardiovascular Outcomes After Breast Cancer Therapy: The CHEMO‐RADIAT Score

Abstract

Background Cardiovascular disease is an important cause of mortality among survivors of breast cancer (BC). We developed a prediction model for major adverse cardiovascular events after BC therapy, which is based on conventional and BC treatment‐related cardiovascular risk factors. Methods and Results The cohort of the study consisted of 1256 Asian female patients with BC from 4 medical centers in Korea and was randomized in a 1:1 ratio into the derivation and validation cohorts. The outcome measures comprised cardiovascular mortality, myocardial infarction, congestive heart failure, and transient ischemic attack/stroke. To correct overfitting, a penalized Cox proportional hazards regression was performed with a cross‐validation approach. Number of cardiovascular diseases (myocardial infarction, peripheral artery disease, heart failure, and transient ischemic attack/stroke), number of baseline cardiovascular risk factors (hypertension, age ≥60, body mass index ≥30 kg/m 2 , estimated glomerular filtration rate <60 mL/min per 1.73 m 2 , dyslipidemia, and diabetes mellitus), radiation to the left breast, and anthracycline dose per 100 mg/m 2 were included in the risk prediction model. The time‐dependent C‐indices at 3 and 7 years after BC diagnosis were 0.876 and 0.842, respectively, in the validation cohort. Conclusions A prediction score model, including BC treatment‐related risk factors and conventional risk factors, was developed and validated to predict major adverse cardiovascular events in patients with BC. The CHEMO‐RADIAT (congestive heart failure, hypertension, elderly, myocardial infarction/peripheral artery occlusive disease, obesity, renal failure, abnormal lipid profile, diabetes mellitus, irradiation of the left breast, anthracycline dose, and transient ischemic attack/stroke) score may provide overall cardiovascular risk stratification in survivors of BC and can assist physicians in multidisciplinary decision‐making regarding the BC treatment.

Is there a window of opportunity to optimize trastuzumab cardiac monitoring?

“…We interpret these factors with caution once the standard of care population is significantly heterogeneous and frequently differs from the subjects included in clinical trials. Moreover, specific recommendations to adapt cardiac monitoring is lacking, unless the patient has a high cardiotoxicity risk[ 29 ].…”

Prior Cancer Is Associated with Lower Atherosclerotic Cardiovascular Disease Risk at First Acute Myocardial Infarction

“…This unaccounted impact of potentially cardiotoxic cancer therapies within the ASCVD score could account for our findings of prior cancer patients developing AMI despite lower ASCVD scores at incident AMI. Several risk scores incorporating cancer treatment variables have been proposed for use within specific cancer subtypes such as breast cancer, but these still require further validation before routine clinical use [ 19 , 20 ]. Second, common pathobiological mechanisms underpinning both cancer and atherosclerosis have been identified.…”

“…The American College of Cardiology have proposed several conditions to be considered as atherosclerotic cardiovascular disease risk enhancers, including inflammatory disease such as rheumatoid arthritis or human immunodeficiency virus infection [ 28 ]. Established risk scores have also been shown to underestimate cardiovascular risk within these specific patient populations [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Hence, we propose that further research is needed to ascertain the value of adding cancer as a variable to the ASCVD score, as well as to identify and include relevant cancer-related variables to improve its applicability within patients with prior cancer.…”

Imaging of heart disease in women: review and case presentation

“…The risk of CAD is particularly increased in women with left breast cancer undergoing radiotherapy, which can induce fibrous stenosis of the left anterior descending artery, and accelerates progression of existing plaques [ 210 ]. Similarly, atherosclerosis progression is accelerated in patients receiving alkylating-like agents, fluoropyrimidines, and platinum compounds (increasing the risk of arterial thrombosis and vasospasm) [ 211 ]. Interestingly, CT scan used to plan radiotherapy for breast cancer also enables measuring CACS, an independent predictor of ischemic heart disease [ 212 ].…”