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Bikomeye JC, Awoyinka I, Kwarteng JL, Beyer AM, Rine S, Beyer KMM. Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature. Heart Lung Circ 2024; 33:576-604. [PMID: 38184426 PMCID: PMC11144115 DOI: 10.1016/j.hlc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. METHODS Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. RESULTS Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. CONCLUSIONS Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.
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Affiliation(s)
- Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Iwalola Awoyinka
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jamila L Kwarteng
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andreas M Beyer
- Department of Medicine and Physiology, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah Rine
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Kim C, Yu H, Kim DK. Association between Head and Neck Cancer and Increased Risk of Ischemic Heart Disease: A Retrospective Cohort Study Using National Population Data. Cancers (Basel) 2024; 16:1352. [PMID: 38611030 PMCID: PMC11011102 DOI: 10.3390/cancers16071352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Although cancer and ischemic heart disease (IHD) frequently manifest in the same individual, the risk of IHD events in cancer, especially head and neck cancer (HNC), remains unclear. We aimed to examine the incidence and risk of IHD events in patients with HNC using a population-based cohort dataset in South Korea (2002-2013). Through rigorous propensity score matching, we compared data from 2816 individuals without HNC and 704 individuals with HNC. Key independent variables were matched between groups, and the Charlson Comorbidity Index was used to match comorbidities. The Kaplan-Meier method depicted the cumulative probability of IHD throughout the follow-up period for both the study and control groups. The overall IHD incidence was significantly higher (19.93) in patients with HNC than in those without HNC (14.81), signifying an augmented IHD risk in the HNC cohort. Subsequent temporal analysis revealed a significant surge in IHD risk commencing 4 years after HNC diagnosis and persisting throughout the follow-up period. Subgroup analysis revealed an increased IHD risk in men with HNC and patients with cancers affecting the oral and sinonasal regions. This retrospective cohort study provides valuable scientific insights into the nuanced relationship between HNC and IHD, underscoring the need for tailored monitoring protocols and specialized care for susceptible individuals.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Hyunjae Yu
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Dong-Kyu Kim
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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Sutton AL, He J, Bottinor W, Hong S, Mitchell K, Hines AL. Examining hypertension risk among Black and White breast cancer survivors. Cancer Med 2024; 13:e6929. [PMID: 38214087 PMCID: PMC10905221 DOI: 10.1002/cam4.6929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Breast cancer survivors are at increased risk of cardiovascular dysfunction following their diagnosis; however, hypertension remains underexplored within this context. This retrospective cohort study examined the incidence of hypertension in breast cancer survivors and the association of race with hypertension risk among them. METHODS Data for this study were abstracted from the electronic health records of women diagnosed with Stages I-III breast cancer. Incident hypertension diagnosis was identified through International Classification of Diseases codes. Bivariate associations were tested using Student's t-test and chi-squared test of independence. Bivariable Cox regression analysis was used to determine demographic and clinical factors that may have been associated with the development of hypertension. RESULTS A total of 664 women were included. Most women were 50 years of age or younger (52.0%), White (33.0% Black), and received a mastectomy (80.6%). Overall, 45.5% of the cohort developed hypertension. The 1-year hypertension-free survival estimates were 47% (95% confidence interval [CI], 41-54) in Black women and 73% (95% CI, 69-77) in White women (p < 0.0001). Besides race, statistically significant predictors of hypertension included: age greater than 50 (vs. ≤50) (adjusted Hazard Ratio [HR]: 1.40; 95% CI, 1.09-1.80) and residing in a non-metropolitan area (vs. metropolitan) (adjusted HR: 1.60; 95% CI, 1.19-2.16). CONCLUSIONS This study suggests that breast cancer survivors who are older, Black, or residing in non-metropolitan areas may benefit from added surveillance and hypertension prevention strategies during treatment. Future studies are needed to identify contributors to the observed racial and geographic disparities.
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Affiliation(s)
- Arnethea L. Sutton
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
- VCU Massey Comprehensive Cancer CenterRichmondVirginiaUSA
| | - Jian He
- VCU Massey Comprehensive Cancer CenterRichmondVirginiaUSA
| | - Wendy Bottinor
- Division of Cardiology, Department of Internal MedicineVCU School of MedicineRichmondVirginiaUSA
| | - Susan Hong
- Division of Hematology/Oncology, Department of Internal MedicineVCU School of MedicineRichmondVirginiaUSA
| | | | - Anika L. Hines
- Department of Health Behavior and PolicyVCU School of MedicineRichmondVirginiaUSA
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