Pub Date : 2024-06-01DOI: 10.1016/j.jaccao.2024.04.004
Biniyam G. Demissei MD, MSC, PhD , Kyunga Ko MS , Anran Huang BA , Daniel J. Lee MD, MS , Abigail G. Doucette MPH , Amanda M. Smith BA, MA , Nicholas S. Wilcox MD, MHS , Jacob Reibel MD , Lova Sun MD, MSCE , Manuj Agarwal MD , Naomi B. Haas MD , Genevieve Hollis CRNP , Jason E. Shpilsky MD , Samuel U. Takvorian MD, MS , David J. Vaughn MD , Jinbo Chen PhD , Rebecca A. Hubbard PhD , Tiffany Powell-Wiley MD, MPH , Clyde Yancy MD, MSc , Vivek Narayan MD, MSCE , Bonnie Ky MD, MSCE
Background
Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in men with prostate cancer; however, data on racial disparities in CVD outcomes are limited.
Objectives
We quantified the disparities in CVD according to self-identified race and the role of the structural social determinants of health in mediating disparities in prostate cancer patients.
Methods
A retrospective cohort study of 3,543 prostate cancer patients treated with systemic androgen deprivation therapy (ADT) between 2008 and 2021 at a quaternary, multisite health care system was performed. The multivariable adjusted association between self-reported race (Black vs White) and incident major adverse cardiovascular events (MACE) after ADT initiation was evaluated using cause-specific proportional hazards. Mediation analysis determined the role of theme-specific and overall social vulnerability index (SVI) in explaining the racial disparities in CVD outcomes.
Results
Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; P < 0.001). The association with Black race was strongest for incident heart failure (HR: 1.79; 95% CI: 1.32-2.43), cerebrovascular disease (HR: 1.98; 95% CI: 1.37-2.87), and peripheral artery disease (HR: 1.76; 95% CI: 1.26-2.45) (P < 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.
Conclusions
Black patients are significantly more likely to experience adverse CVD outcomes after systemic ADT compared with their White counterparts. These disparities are mediated by socioeconomic status and other structural determinants of health as captured by census tract SVI. Our findings motivate multilevel interventions focused on addressing socioeconomic vulnerability.
{"title":"Social Determinants of Health Mediate Racial Disparities in Cardiovascular Disease in Men With Prostate Cancer","authors":"Biniyam G. Demissei MD, MSC, PhD , Kyunga Ko MS , Anran Huang BA , Daniel J. Lee MD, MS , Abigail G. Doucette MPH , Amanda M. Smith BA, MA , Nicholas S. Wilcox MD, MHS , Jacob Reibel MD , Lova Sun MD, MSCE , Manuj Agarwal MD , Naomi B. Haas MD , Genevieve Hollis CRNP , Jason E. Shpilsky MD , Samuel U. Takvorian MD, MS , David J. Vaughn MD , Jinbo Chen PhD , Rebecca A. Hubbard PhD , Tiffany Powell-Wiley MD, MPH , Clyde Yancy MD, MSc , Vivek Narayan MD, MSCE , Bonnie Ky MD, MSCE","doi":"10.1016/j.jaccao.2024.04.004","DOIUrl":"https://doi.org/10.1016/j.jaccao.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in men with prostate cancer; however, data on racial disparities in CVD outcomes are limited.</p></div><div><h3>Objectives</h3><p>We quantified the disparities in CVD according to self-identified race and the role of the structural social determinants of health in mediating disparities in prostate cancer patients.</p></div><div><h3>Methods</h3><p>A retrospective cohort study of 3,543 prostate cancer patients treated with systemic androgen deprivation therapy (ADT) between 2008 and 2021 at a quaternary, multisite health care system was performed. The multivariable adjusted association between self-reported race (Black vs White) and incident major adverse cardiovascular events (MACE) after ADT initiation was evaluated using cause-specific proportional hazards. Mediation analysis determined the role of theme-specific and overall social vulnerability index (SVI) in explaining the racial disparities in CVD outcomes.</p></div><div><h3>Results</h3><p>Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; <em>P</em> < 0.001). The association with Black race was strongest for incident heart failure (HR: 1.79; 95% CI: 1.32-2.43), cerebrovascular disease (HR: 1.98; 95% CI: 1.37-2.87), and peripheral artery disease (HR: 1.76; 95% CI: 1.26-2.45) (<em>P <</em> 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.</p></div><div><h3>Conclusions</h3><p>Black patients are significantly more likely to experience adverse CVD outcomes after systemic ADT compared with their White counterparts. These disparities are mediated by socioeconomic status and other structural determinants of health as captured by census tract SVI. Our findings motivate multilevel interventions focused on addressing socioeconomic vulnerability.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 390-401"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001480/pdfft?md5=b0f8efa70d99a66abc283d1cbfae2d03&pid=1-s2.0-S2666087324001480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Walk Your Way Out of Cardiovascular Risk","authors":"Ashish Kumar MD , Sourbha S. Dani MD, MSc , Sarju Ganatra MD","doi":"10.1016/j.jaccao.2024.04.005","DOIUrl":"https://doi.org/10.1016/j.jaccao.2024.04.005","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 436-438"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001492/pdfft?md5=108e1e9fa04cedca5ecc6a77f8c74dce&pid=1-s2.0-S2666087324001492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jaccao.2024.05.006
Trejeeve Martyn MD, MSc , Julia M. Simkowski MD , Mazen Hanna MD
{"title":"Understanding Race, Genotype, and Socioeconomic Status in Transthyretin Amyloid Cardiomyopathy","authors":"Trejeeve Martyn MD, MSc , Julia M. Simkowski MD , Mazen Hanna MD","doi":"10.1016/j.jaccao.2024.05.006","DOIUrl":"https://doi.org/10.1016/j.jaccao.2024.05.006","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 464-466"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001583/pdfft?md5=3305344a6b6726c935136c22267ba573&pid=1-s2.0-S2666087324001583-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jaccao.2023.10.010
Linda A. Jacobs PhD, CRNP , Lawrence N. Shulman MD
{"title":"Cardio-Oncology Care Delivery for All Patients With Cancer Within Academic and Community Settings","authors":"Linda A. Jacobs PhD, CRNP , Lawrence N. Shulman MD","doi":"10.1016/j.jaccao.2023.10.010","DOIUrl":"10.1016/j.jaccao.2023.10.010","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 470-472"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003538/pdfft?md5=7a6dc911640799cdb2d991c5d2184efb&pid=1-s2.0-S2666087323003538-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jaccao.2024.02.009
Foster Osei Baah MS, PhD, RN , Sonal Sharda MHS , Kimberly Davidow MD , Sadhana Jackson MD , Daphney Kernizan DO , Joshua A. Jacobs PharmD , Yvonne Baumer PharmD, PhD , Corinna L. Schultz MD , Carissa M. Baker-Smith MD, MPH , Tiffany M. Powell-Wiley MD, MPH
Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.
{"title":"Social Determinants of Health in Cardio-Oncology","authors":"Foster Osei Baah MS, PhD, RN , Sonal Sharda MHS , Kimberly Davidow MD , Sadhana Jackson MD , Daphney Kernizan DO , Joshua A. Jacobs PharmD , Yvonne Baumer PharmD, PhD , Corinna L. Schultz MD , Carissa M. Baker-Smith MD, MPH , Tiffany M. Powell-Wiley MD, MPH","doi":"10.1016/j.jaccao.2024.02.009","DOIUrl":"10.1016/j.jaccao.2024.02.009","url":null,"abstract":"<div><p>Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 331-346"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001418/pdfft?md5=aadc981182a3fc99af789a7bdaa8b968&pid=1-s2.0-S2666087324001418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jaccao.2024.03.010
Lauren L. Taylor MD , Arthur S. Hong MD, MPH , Kristine Hahm MPP , Dohyeong Kim PhD , Carolyn Smith-Morris PhD , Vlad G. Zaha MD, PhD
Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient’s perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.
{"title":"Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities","authors":"Lauren L. Taylor MD , Arthur S. Hong MD, MPH , Kristine Hahm MPP , Dohyeong Kim PhD , Carolyn Smith-Morris PhD , Vlad G. Zaha MD, PhD","doi":"10.1016/j.jaccao.2024.03.010","DOIUrl":"10.1016/j.jaccao.2024.03.010","url":null,"abstract":"<div><p>Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient’s perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 363-380"},"PeriodicalIF":11.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001431/pdfft?md5=05749411d0ab23aee45e3d287598ff10&pid=1-s2.0-S2666087324001431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}