Cardiovascular risk factors during cancer treatment. Prevalence and prognostic relevance: insights from the CARDIOTOX registry
Juan Caro-Codón 1 , Teresa López-Fernández 1 , Carlos Álvarez-Ortega 1 , Pilar Zamora Auñón 2 , Isabel Rodríguez Rodríguez 3 , Pilar Gómez Prieto 4 , Antonio Buño Soto 5 , Miguel Canales Albendea 4 , Ainara Albaladejo 1 , Guiomar Mediavilla 1 , Jaime Feliu Batlle 2 , Olaia Rodríguez Fraga 5 , Amparo Martínez Monzonis 6 , José González-Costello 7 , José María Serrano Antolín 8 , Rosalía Cadenas Chamorro 9 , José R González-Juanatey 6 , José López-Sendón 1 , CARDIOTOX registry investigators
Aims: The actual usefulness of cardiovascular (CV) risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Prospective multicentre study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk.
Methods and results: A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples, and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years, and 2 years after initiation of cancer therapy. At baseline, 893 patients (67.4%) presented at least one risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity (CTox) and all-cause mortality [hazard ratio (HR) 1.79 (95% confidence interval, CI 1.16-2.76) for SCORE 5-9 and HR 4.90 (95% CI 2.44-9.82) for SCORE ≥10 when compared with patients with lower SCORE (0-4)].
Conclusions: This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline CV risk assessment using SCORE predicted severe CTox and all-cause mortality. Therefore, its use should be considered in the evaluation of cancer patients.
Trial registration: ClinicalTrials.gov NCT02039622.