{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:43:34Z","timestamp":1785285814106,"version":"3.55.0"},"reference-count":32,"publisher":"Royal College of General Practitioners","issue":"726","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cardiovascular risks are raised in cancer survivors but cancer history is not included in cardiovascular risk scores that inform preventive decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess whether cancer diagnosis should be included in cardiovascular risk scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Cohort study using data from English general practices linked to hospital, cancer registration, and death registration data from 1990 to 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Adults alive 1 year after a first cancer diagnosis and age, sex, general practice, and calendar-\u200atime matched cancer-free individuals were included. Individuals with &lt;2 years of follow-up before index, recent statin prescriptions, or pre-existing coronary heart or cerebrovascular disease were excluded. Cox proportional hazard models used to develop QRISK3 scores were replicated with added cancer history variables. Whether independent hazard ratios for these variables met thresholds for inclusion in QRISK3 (&gt;10% relative difference with<jats:italic>P<\/jats:italic>&lt;0.01) was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 81 420 cancer survivors and 413 547 cancer-free individuals were followed for a median 5.2 years (interquartile range [IQR] 2.8\u2013\u200a9.1) and 6.3 years (IQR 3.5\u201310.2), respectively. Including a 1-year cancer survivorship variable in a QRISK3-based model met the threshold for inclusion for males (independent hazard ratio [iHR] 1.16, 95% confidence interval [CI] = 1.11 to 1.20,<jats:italic>P<\/jats:italic>&lt;0.001) but not females (iHR 1.07, 95% CI = 1.01 to 1.14,<jats:italic>P<\/jats:italic>= 0.02). When including cancer type, the threshold was met for both sexes with history of haematological cancer (males: iHR 1.27, 95% CI = 1.16 to 1.40,<jats:italic>P<\/jats:italic>&lt;0.001; females: iHR 1.59, 95% CI = 1.32 to 1.91,<jats:italic>P<\/jats:italic>&lt;0.001) and for males but not females with history of solid cancers (males: iHR 1.13, 95% CI = 1.08 to 1.18,<jats:italic>P<\/jats:italic>&lt;0.001; females: iHR 1.04, 95% CI = 0.98 to 1.10,<jats:italic>P<\/jats:italic>= 0.19).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Developers should consider including cancer history variables in future cardiovascular risk models.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2022.0088","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T17:50:14Z","timestamp":1665165014000},"page":"e34-e42","source":"Crossref","is-referenced-by-count":10,"title":["Cancer history as a predictor in cardiovascular risk scores: a primary care cohort study"],"prefix":"10.3399","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8739-4601","authenticated-orcid":false,"given":"Helen","family":"Strongman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9425-644X","authenticated-orcid":false,"given":"Emily","family":"Herrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5914-6934","authenticated-orcid":false,"given":"Rod","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0980-8965","authenticated-orcid":false,"given":"Michael","family":"Sweeting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8026-840X","authenticated-orcid":false,"given":"Alexander R","family":"Lyon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8438-3672","authenticated-orcid":false,"given":"Susannah","family":"Stanway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0127-5236","authenticated-orcid":false,"given":"Claire","family":"Lawson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4433-2977","authenticated-orcid":false,"given":"Umesh","family":"Kadam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9168-6022","authenticated-orcid":false,"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5364-8757","authenticated-orcid":false,"given":"Krishnan","family":"Bhaskaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2022,10,7]]},"reference":[{"key":"2023041202501709000_73.726.e34.1","unstructured":"Cancer Research UK (2019) Cancer statistics for the UK. https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics-for-the-uk (accessed 18 Nov 2022)."},{"key":"2023041202501709000_73.726.e34.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31674-5"},{"key":"2023041202501709000_73.726.e34.3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.0409"},{"issue":"4","key":"2023041202501709000_73.726.e34.4","doi-asserted-by":"crossref","first-page":"e513","DOI":"10.1212\/WNL.0000000000011264","article-title":"Risk of stroke in cancer survivors: a meta-analysis of population-based cohort studies","volume":"96","author":"Zhang","year":"2021","journal-title":"Neurology"},{"key":"2023041202501709000_73.726.e34.5","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28385"},{"key":"2023041202501709000_73.726.e34.6","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju110"},{"key":"2023041202501709000_73.726.e34.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022514"},{"key":"2023041202501709000_73.726.e34.8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw211"},{"key":"2023041202501709000_73.726.e34.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.1095"},{"key":"2023041202501709000_73.726.e34.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.1096"},{"issue":"7","key":"2023041202501709000_73.726.e34.11","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.cjca.2016.02.078","article-title":"Canadian Cardiovascular Society guidelines for evaluation and management of cardiovascular complications of cancer therapy","volume":"32","author":"Virani","year":"2016","journal-title":"Can J Cardiol"},{"key":"2023041202501709000_73.726.e34.12","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000556"},{"issue":"10203","key":"2023041202501709000_73.726.e34.13","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/S0140-6736(19)31886-0","article-title":"Is it time to include cancer in cardiovascular risk prediction tools?","volume":"394","author":"Blaes","year":"2019","journal-title":"Lancet"},{"key":"2023041202501709000_73.726.e34.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39609.449676.25"},{"key":"2023041202501709000_73.726.e34.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2099"},{"key":"2023041202501709000_73.726.e34.16","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2023041202501709000_73.726.e34.17","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx015"},{"issue":"1","key":"2023041202501709000_73.726.e34.18","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ije\/dyz076","article-title":"Data resource profile: National Cancer Registration Dataset in England","volume":"49","author":"Henson","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2023041202501709000_73.726.e34.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-037719"},{"key":"2023041202501709000_73.726.e34.20","unstructured":"Gadd S Herrett E Strongman H (2022) emilyherrett\/qrisk_cprd_gold: QRISK bundle version 2.0, code lists added in version 5.0. https:\/\/zenodo.org\/record\/3981238 (accessed 18 Nov 2022)."},{"key":"2023041202501709000_73.726.e34.21","unstructured":"ClinRisk Ltd (2017) QRISK3-2017. https:\/\/qrisk.org\/three\/src.php (accessed 18 Nov 2022)."},{"key":"2023041202501709000_73.726.e34.22","unstructured":"National Clinical Guidance Centre (2016) Cardiovascular disease: risk assessment and reduction, including lipid modification CG181, https:\/\/www.nice.org.uk\/guidance\/cg181 (accessed 18 Nov 2022)."},{"key":"2023041202501709000_73.726.e34.23","unstructured":"Strongman H (2022) emilyherrett\/qrisk_cprd_gold: multiple imputation do file added, https:\/\/zenodo.org\/record\/5909728#.YfqirprP2Uk (accessed 18 Nov 2022)."},{"key":"2023041202501709000_73.726.e34.24","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"issue":"23","key":"2023041202501709000_73.726.e34.25","doi-asserted-by":"crossref","first-page":"4512","DOI":"10.1002\/cncr.31775","article-title":"Changes in cardiovascular disease risk and risk factors among women with and without breast cancer","volume":"124","author":"Anderson","year":"2018","journal-title":"Cancer"},{"issue":"4","key":"2023041202501709000_73.726.e34.26","doi-asserted-by":"crossref","first-page":"e761","DOI":"10.1016\/j.clgc.2018.01.011","article-title":"Predicting cardiovascular disease among testicular cancer survivors after modern cisplatin-based chemotherapy: application of the Framingham Risk Score","volume":"16","author":"Feldman","year":"2018","journal-title":"Clin Genitourin Cancer"},{"key":"2023041202501709000_73.726.e34.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.11.008"},{"issue":"4","key":"2023041202501709000_73.726.e34.28","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/IGC.0b013e3181a13058","article-title":"Prevalence and determinants of metabolic syndrome and elevated Framingham risk score in epithelial ovarian cancer survivors: a controlled observational study","volume":"19","author":"Liavaag","year":"2009","journal-title":"Int J Gynecol Cancer"},{"issue":"3","key":"2023041202501709000_73.726.e34.29","doi-asserted-by":"crossref","first-page":"e0247919","DOI":"10.1371\/journal.pone.0247919","article-title":"Ten-year cardiovascular risk among cancer survivors: the National Health and Nutrition Examination Survey","volume":"16","author":"Zhang","year":"2021","journal-title":"PLoS One"},{"issue":"4","key":"2023041202501709000_73.726.e34.30","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4082\/kjfm.2016.37.4.235","article-title":"Risk of cardiovascular disease using Framingham Risk Score in Korean cancer survivors","volume":"37","author":"So","year":"2016","journal-title":"Korean J Fam Med"},{"issue":"1","key":"2023041202501709000_73.726.e34.31","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1186\/s12885-018-4947-8","article-title":"Statin use in cancer survivors versus the general population: cohort study using primary care data from the UK clinical practice research datalink","volume":"18","author":"Chidwick","year":"2018","journal-title":"BMC Cancer"},{"key":"2023041202501709000_73.726.e34.32","doi-asserted-by":"crossref","unstructured":"Walter FM Usher-Smith JA Yadlapalli S Watson E (2015) Caring for people living with, and beyond, cancer: an online survey of GPs in England. Br J Gen Pract, https:\/\/doi.org\/10.3399\/bjgp15X687409.","DOI":"10.3399\/bjgp15X687409"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2022.0088","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T09:52:46Z","timestamp":1681293166000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2022.0088"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,7]]},"references-count":32,"journal-issue":{"issue":"726","published-online":{"date-parts":[[2022,12,21]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.3399\/BJGP.2022.0088"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2022.0088","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,7]]}}}