van den Berg Pieter F, Yousif Laura I, Koop Yvonne, Ünlü Ezgi Hatip, Asik Melis, van Essen Bart J, Damman Kevin, Voors Adriaan A, Sayour Nabil V, Kok Thomas F, Yang Yiqian, Kardys Isabella, Bakker Stephan J L, van der Vegt Bert, Suthahar Navin, de Boer Rudolf A, Meijers Wouter C
Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, 3015GD, Rotterdam, The Netherlands.
Cardiovascular Epidemiology, Julius Centre for Health Sciences and Primary Care, Utrecht University Medical Centre, Utrecht University, Utrecht, The Netherlands.
Eur J Prev Cardiol. 2026 Mar 13;33(4):490-497. doi: 10.1093/eurjpc/zwaf618.
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.
弗雷明汉风险评分（FRS）是一种主要用于动脉粥样硬化性心血管疾病（ASCVD）风险分层的工具，纳入了年龄、肥胖和吸烟等因素。然而，其在预测癌症和心力衰竭（HF）风险方面的作用仍不明确，而新出现的数据表明这两种情况经常同时出现。
我们使用来自预防肾脏和血管终末期疾病（PREVEND）研究的数据进行了一项事后分析，并在英国生物银行中验证了我们的研究结果。我们研究了基线时FRS三分位数与新发癌症或HF之间的关联。使用Fine-Gray回归模型计算亚分布风险比（sHRs），并对估计肾小球滤过率和尿白蛋白排泄进行调整，将全因死亡率作为竞争风险。在PREVEND研究中，我们纳入了8123名参与者（平均年龄49±13岁，50%为女性）。在17.46年的随访期内[四分位间距（IQR）17.15 - 17.80]（癌症）和23.39年（IQR 13.78 - 23.81）（HF），1176名参与者出现了新发癌症，758名参与者出现了新发HF。在多变量分析中，与最低FRS三分位数的参与者相比，最高FRS三分位数的参与者患癌症（sHR 2.32，P < 0.001）和HF（sHR 10.08，P < 0.001）的风险更高。最高FRS三分位数的参与者的生存率也最差（对数秩检验P < 0.001）。我们在英国生物银行（n = 389942）中验证了这些结果，其中与最低三分位数的个体相比，最高FRS三分位数的个体患癌症（sHR 2.05，P < 0.001）和HF（sHR 5.99，P < 0.001）的风险也更高。
FRS与新发癌症或HF相关，这意味着FRS在心血管肿瘤学中除了ASCVD风险分层之外还有更广泛的临床应用。
