Framingham risk score associates with incident cancer and heart failure

The Framingham risk score (FRS), a tool primarily used for atherosclerotic cardiovascular disease (ASCVD) risk stratification, incorporates factors like age, obesity, and smoking. However, its role in predicting cancer and heart failure (HF) risk remains unclear, while emerging data suggest these two conditions coincide frequently.

We conducted a post hoc analysis using data from the PREVEND study and validated our findings in the UK Biobank. We examined the association between FRS tertiles at baseline and incident cancer or HF. Fine-Gray regression models were used to calculate subdistribution hazard ratios (sHRs), adjusting for estimated glomerular filtration rate and urinary albumin excretion with all-cause mortality as a competing risk. In PREVEND, we included 8123 participants (mean age 49 ± 13 years, 50% female). Over follow-up periods of 17.46 years [interquartile range (IQR) 17.15-17.80] (cancer) and 23.39 years (IQR 13.78-23.81) (HF), 1176 participants developed new-onset cancer and 758 developed new-onset HF. In a multivariable analysis, participants in the highest FRS tertile compared with the lowest had a higher hazard for both cancer (sHR 2.32, P < 0.001) and HF (sHR 10.08, P < 0.001). Participants in the highest FRS tertile also had the worst survival (log-rank P < 0.001). We validated these findings in the UK Biobank (n = 389942) wherein individuals in the highest FRS tertile also had a higher hazard for both cancer (sHR 2.05, P < 0.001) and HF (sHR 5.99, P < 0.001) compared with the lowest tertile.

The FRS associates with new-onset cancer or HF, implicating a broader clinical application of the FRS beyond ASCVD risk stratification in cardio-oncology.