Predictive validity of the ACC/AHA pooled cohort equations in predicting cancer-specific mortality in a National Prospective Cohort Study of Adults in the United States

BackgroundThe American College of Cardiology/American Heart Association Task Force on Practice Guidelines recently developed the Pooled Cohort Risk (PCR) equations to predict 10-years risk for a first atherosclerotic cardiovascular disease (ASCVD) event. The predictive validity of these PCR equations on cancer-specific mortality among a national sample of US adults has yet to be evaluated, which was this study's purpose. MethodsData from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed through December 31, 2011 to ascertain cancer mortality status via the National Death Index probabilistic algorithm. The analysed sample included 11,171 CVD-free adults (40-79 years). Ten-year risk of a first ASCVD was determined from the PCR equations. ResultsFor the entire sample, 849,202 person-months occurred with an incidence rate of 0.31 cancer-specific deaths per 1,000 person-months. The unweighted follow-up duration was 72 months (IQR = 39-114). After adjusting for age, gender, race-ethnicity, physical activity and obesity, those with an elevated ASCVD ( 7.5%) whom did not have a history of cancer at baseline had a 71% increased risk of cancer-specific mortality. There was less evidence for this relationship among those with a history of cancer. The individual components of the ASCVD that were predictive of cancer-specific mortality included age and smoking status. ConclusionTen-year predicted risk of a first ASCVD event via the PCR equations were significantly associated with cancer-specific mortality in a national sample of US adults (40-79 years) whom were free of cancer and CVD at baseline. In this American adult sample, the PCR equations provide evidence of predictive validity for cancer-specific mortality, particularly among those without cancer.