ASCVD risk assessment in cancer survivorship care.

Abstract

653 Background: Cancer survivors are at increased risk for cardiovascular disease due to shared risk factors, cardiotoxic therapies, and extended life expectancy. National standards, including Commission on Cancer Standard 4.8, emphasize survivorship care planning that addresses chronic disease risk; however, cardiovascular risk assessment is not consistently integrated into survivorship workflows. To address this gap, MD Anderson Cancer Center implemented the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator within the Epic electronic health record (EHR) to standardize assessment and support evidence-based decision-making. Methods: In January 2025, the ASCVD Risk Calculator was embedded into Epic with supporting clinical decision tools, provider education, and workflow integration. Survivorship encounters utilizing the calculator were identified. A cross-sectional analysis of de-identified data was conducted, including age, gender, and ASCVD risk scores categorized as low (<5%), borderline (5–7.4%), intermediate (7.5–19.9%), and high (≥20%). Results: The study included 376 adult survivors aged 40–79 years, primarily in the mid-50s to mid-70s. ASCVD risk ranged from <1% to >50%, demonstrating substantial variability. Risk distribution was as follows: Low 31.1%, Borderline 12.0%, Intermediate 32.2%, High 24.7%. Nearly 1 in 4 patients were high-risk, while 44% were intermediate or borderline, representing a modifiable population for prevention. Conclusions: EHR-integrated ASCVD risk assessment is a feasible strategy to strengthen survivorship care. Many survivors exhibit elevated cardiovascular risk, underscoring the need for timely, targeted preventive interventions. Notably, current ASCVD risk calculators do not account for cancer-related treatment exposures and may therefore underestimate true cardiovascular risk in this population. These findings reinforce the imperative for comprehensive survivorship care models that systematically address long-term cardiovascular risk to reduce late morbidity across this growing cohort. Broader implementation could improve outcomes and standardize survivorship care across cancer centers.