People with cancer have an increased risk of cardiovascular disease. Risk prediction equations developed in New Zealand accurately predict 5-year cardiovascular disease risk in a general primary care population in the country. We assessed the performance of these equations for survivors of cancer in New Zealand. For this validation study, patients aged 30–74 years from the PREDICT open cohort study, which was used to develop the New Zealand cardiovascular disease risk prediction equations, were included in the analysis if they had a primary diagnosis of invasive cancer at least 2 years before the date of the first cardiovascular disease risk assessment. The risk prediction equations are sex-specific and include the following predictors: age, ethnicity, socioeconomic deprivation index, family history of cardiovascular disease, smoking status, history of atrial fibrillation and diabetes, systolic blood pressure, total cholesterol to HDL cholesterol ratio, and preventive pharmacotherapy (blood-pressure-lowering, lipid-lowering, and antithrombotic drugs). Calibration was assessed by comparing the mean predicted 5-year cardiovascular disease risk, estimated using the risk prediction equations, with the observed risk across deciles of risk, for men and women, and according to the three clinical 5-year cardiovascular disease risk groups in New Zealand guidelines (<5%, 5% to <15%, and ≥15%). Discrimination was assessed by Harrell's C statistic. 14 263 patients were included in the study. The mean age was 61 years (SD 9) for men and 60 years (SD 8) for women, with a median follow-up of 5·8 years for men and 5·7 years for women. The observed cardiovascular disease risk was underpredicted by a maximum of 2·5% in male and 3·2% in female decile groups. When patients were grouped according to clinical risk groups, observed cardiovascular disease risk was underpredicted by less than 2% in the lower risk groups and overpredicted by 2·2% for men and 3·3% for women in the highest risk group. Harrell's C statistics were 0·67 (SE 0·01) for men and 0·73 (0·01) for women. The New Zealand cardiovascular disease risk prediction equations reasonably predicted the observed 5-year cardiovascular disease risk in survivors of cancer in the country, in whom risk prediction was considered clinically appropriate. Prediction could be improved by adding cancer-specific variables and considering competing risks. Our findings suggest that the equations are reasonable clinical tools for use in survivors of cancer in New Zealand. Auckland Medical Research Foundation, Health Research Council of New Zealand.

中文翻译：

---

新西兰初级保健中超过 14 000 名癌症幸存者的心血管疾病风险预测方程的表现：一项验证研究

癌症患者患心血管疾病的风险增加。新西兰开发的风险预测方程准确预测了该国普通初级保健人群的 5 年心血管疾病风险。我们评估了这些方程对新西兰癌症幸存者的表现。在这项验证研究中，来自 PREDICT 开放队列研究（用于开发新西兰心血管疾病风险预测方程）的 30-74 岁患者如果至少 2 年初步诊断为浸润性癌症，则被纳入分析。在第一次心血管疾病风险评估日期之前。风险预测方程是针对性别的，包括以下预测因素：年龄、种族、社会经济剥夺指数、心血管疾病家族史、吸烟状况、心房颤动和糖尿病史、收缩压、总胆固醇与高密度脂蛋白胆固醇的比率，以及预防性药物治疗（降血压、降脂、抗血栓药物）。通过比较男性和女性的平均预测 5 年心血管疾病风险（使用风险预测方程估计）与十分位风险中观察到的风险，并根据三个临床 5 年心血管疾病风险组进行校准评估。新西兰指南（<5%、5% 至 <15% 和 ≥15%）。歧视是通过 Harrell 的 C 统计来评估的。该研究纳入了 14 263 名患者。男性平均年龄为 61 岁 (SD 9)，女性为 60 岁 (SD 8)，男性中位随访时间为 5·8 年，女性为 5·7 年。观察到的心血管疾病风险在十等分组中男性最多被低估了 2·5%，女性最多被低估了 3·2%。当患者根据临床风险组进行分组时，观察到的心血管疾病风险在较低风险组中被低估了不到 2%，在最高风险组中，男性高估了 2·2%，女性高估了 3·3%。Harrell 的 C 统计数据男性为 0·67 (SE 0·01)，女性为 0·73 (0·01)。新西兰心血管疾病风险预测方程合理地预测了该国癌症幸存者观察到的5年心血管疾病风险，其中风险预测被认为在临床上是适当的。通过添加癌症特定变量并考虑竞争风险可以改善预测。我们的研究结果表明，这些方程是用于新西兰癌症幸存者的合理临床工具。奥克兰医学研究基金会、新西兰健康研究委员会。