{
  "abstract": "Introduction Cardiovascular disease (CVD) and cancer are leading causes of death. Individuals with cancer face elevated risk of CVD, due to shared risk factors, systemic inflammation, and potential cardiotoxic effects from cancer therapies. Predicted Heart Age (PHA) is a simple communication tool that translates traditional cardiovascular risk factors into the equivalent ‘chronological age’ of a person with an optimal cardiovascular risk profile but identical CVD risk. Excess Heart Age (EHA), the difference between predicted and chronological age, provides further context by estimating age-standardised cardiovascular ageing. PHA among individuals with cancer, and its distribution between cancer types is unknown. This study explored the relationship between PHA, EHA, and cancer status in a nationally representative U.S. dataset.Methods 13,771 NHANES participants (2009-2018), representing 122,772,557 U.S. adults aged 30-74 years and who were free from prevalent CVD, were included in the analysis. PHA was derived using the laboratory-based Framingham Risk Score with sex-specific algorithms incorporating age, lipid profiles, systolic blood pressure, smoking, and diabetes status. Survey-weighted multivariable models examined associations of PHA and EHA, by cancer status. All-cause mortality was assessed using Cox proportional hazards models, while cardiovascular mortality was analysed with Fine–Gray competing risk models. Survival patterns for chronological age, PHA, and EHA were evaluated using Kaplan–Meier curves stratified by cancer status.Results Individuals with cancer had higher mean PHA (65.88 vs 54.20 years) and EHA (7.79 vs 5.53 years) than those without cancer (both P<0.001), with differences in age-stratified PHA remaining significant in participants aged 45–59 and 60–74 years. Heart age metrics differed by cancer type, with the largest increases in PHA seen in bladder, lung, and prostate cancers, and the highest unadjusted EHA in lung, bladder, kidney, and ovarian cancers. Chronological age was the strongest continuous predictor of all-cause mortality (adjusted HR per year 1.07 [1.03–1.10] in cancer; 1.07 [1.05–1.08] in non-cancer), though PHA showed similar categorical risk discrimination. In contrast, EHA added little prognostic information after adjustment for sociodemographic factors.Conclusions This study provides the first evaluation of PHA in relation to mortality by cancer status using NHANES data. Despite elevated PHA and EHA in those with cancer, incorporation of cancer-specific factors such as treatment exposure and biomarkers of inflammation or myocardial injury may enhance the prognostic utility of heart age metrics in this population.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Royal Stoke University Hospital, Newcastle-under-Lyme, United Kingdom"
      ],
      "name": "Maxim Rees"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Stoke University Hospital, Newcastle-under-Lyme, United Kingdom",
        "Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Newcastle-under-Lyme, United Kingdom"
      ],
      "name": "Mustafa Al-Jarshawi"
    },
    {
      "affiliations": [
        "Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel"
      ],
      "name": "Elad Asher"
    },
    {
      "affiliations": [
        "Division of Cardiology, Schulich Heart Center, Sunnybrook Health Sciences Centre, Toronto, Canada"
      ],
      "name": "Harindra C Wijeysundera"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Stoke University Hospital, Newcastle-under-Lyme, United Kingdom",
        "Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Newcastle-under-Lyme, United Kingdom"
      ],
      "name": "Mamas A Mamas"
    }
  ],
  "title": "493 Predicted and excess heart age and their prognostic value among individuals with and without cancer: insights from nhanes",
  "uid": "c469e4e7-0170-597c-973b-8bf6b5d7046c"
}