Aims: 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.
Methods and results: 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.
Conclusion: The FRS associates with new-onset cancer or HF, implicating a broader clinical application of the FRS beyond ASCVD risk stratification in cardio-oncology.
Keywords: Cardio-oncology; Framingham risk score; Heart failure; New-onset cancer; Risk stratification.
Heart disease and cancer are the two most common causes of death worldwide. They are usually treated as separate problems, but research shows they can be connected. For example, some cancer treatments can damage the heart, and people with heart problems may also have a higher risk of cancer. In this study, we looked at whether a simple heart health score—the Framingham risk score (FRS)—can also help predict who might get cancer or heart failure in the future. This score is usually used to estimate a person’s risk of heart disease over 10 years. We used health data from two large groups of people: one from the Netherlands (PREVEND) and one from the UK (UK Biobank), following them for up to 23 years. We found that people with a high FRS were more likely to develop both cancer and heart failure compared with those with a low score. This means the FRS could be useful not just for predicting heart problems but also for spotting people at higher risk of serious illnesses like cancer. Doctors could then take early steps like lifestyle changes, better treatment of blood pressure or cholesterol, and more regular health checks to help prevent these diseases. Our study suggests that looking at heart and cancer risks together could lead to better care and prevention in the future.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.