The Framingham Risk Score Underestimates the Risk of Cardiovascular Events in the HER2-Positive Breast Cancer Population
Bibliographic record
Abstract
Introduction: Patients with breast cancer (BCa) who overexpress HER2 (the human epidermal growth factor receptor 2) are at risk for cardiotoxicity when treated with anthracycline-based chemotherapy and HER2-targeted agents. The Framingham risk score (FRS) is a validated tool that stratifies patients into high-, intermediate-, or low-risk groups and calculates their 10-year risk of developing cardiovascular disease (CVD) based on past medical history, systolic blood pressure, and measurement of serum lipids. We retrospectively analyzed patients with HER2-positive BCa to determine whether the FRS predicts adverse cardiovascular (CV) events or cardiotoxicity in patients treated using anthracyclines or HER2-targeted therapy, or both. Methods: The FRS was determined for patients with BCa referred to The Ottawa Hospital Cardiology–Oncology Clinic from October 2008 to August 2014. The patients were stratified into high (≥20%), intermediate (10%–20%), and low (<10%) 10-year CV risk groups. Primary outcomes included CVD-related hospitalizations and deaths, and cardiotoxicity [drop in left ventricular ejection fraction (LVEF) of >10% to a LVEF ≤50%]. Results: Of the 152 patients included in the analysis (median follow-up: 40.7 months; range: 3.5–263 months), 47 (31%) were classified as high risk; 36 (24%), as intermediate risk; and 69 (45%), as low-risk. The number of CVD-related hospitalizations and deaths was 22, for an overall prevalence of 14%, with significantly more events occurring in high-risk than in low-risk patients (odds ratio: 4.18; 95% confidence limits: 1.47, 11.89). The FRS predicted a 10-year risk of any cv event of 11.2% and underestimated the actual rate of cv events in the entire cohort. High FRS was not associated with cardiotoxicity (p = 0.82). Conclusions: In a population of patients with HER2-positive BCa referred to a cardiology–oncology clinic, the FRS does not accurately predict the risk of cv events or cardiotoxicity.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".