Incorporating poor oral health into pre-chemotherapy heart failure association/international cardio-oncology society (HFA-ICOS) baseline cardiovascular risk stratification

Introduction

Pre-chemotherapy risk assessment using the Heart Failure Association – International Cardio-Oncology Society (HFA-ICOS) score helps identify patients at risk for cancer therapy–related cardiac dysfunction (CTRCD). [1] Oral health is a potentially modifiable factor that may contribute to cardiovascular vulnerability. [2] In the ROOT-CTRCD study, poor oral health was significantly associated with increased risk and delayed recovery of CTRCD in patients receiving HER2-targeted therapy. [3] Poor oral health was also evaluated as an additional point in the HFA-ICOS risk score to assess potential reclassification of risk (Fig. 1).

Methods

This post-hoc analysis was conducted using data from the ROOT-CTRCD study. Among 604 patients treated with trastuzumab, 307 completed all planned cycles and had at least one year of follow-up. Patients with prior chemotherapy, major cardiovascular comorbidities, smoking, chronic kidney disease, ischemic heart disease, heart failure, dyslipidaemia, or established risk factors for periodontitis were excluded. The final analysis included 62 patients who developedCTRCDand 65 matched controls. Baseline oral health was assessed using the DMFT index and periodontal staging/grading.Patients were categorized into poor or good oral health groups.Logistic regression and receiver operating characteristic (ROC) analyses were performed, and positive and negative predictive values were calculated to evaluate the predictive value of oral health for CTRCD (Fig. 2).Results:

Poor oral health was more frequent in the CTRCD group (40/62) than in controls (21/65), corresponding to an odds ratio of 3.8 (p < 0.001). ROC analysis of oral health alone yielded an AUC of 0.66, with a positive predictive value of 65.6% and negative predictive value of 66.7%. Incorporation of poor oral health as 1 additional point in the HFA-ICOS risk score would reclassify all previously low-risk patients as intermediate risk, potentially improving sensitivity for identifying patients at risk for CTRCD.

Conclusions

Adding poor oral health to the pre-chemotherapy HFA-ICOS risk score may enhance early identification of patients at increased risk of CTRCD. These results support considering oral health as a modifiable risk factor in baseline cardiovascular risk assessment, and prospective studies are warranted to validate this approach.Figure 1  Figure 2