Objectives: Investigate the use of cardiac resynchronization therapy (CRT) in cancer patients with heart failure (HF); assess factors associated with ischemic and non-ischemic HF.
Background: Many newer cancer therapies are cardiotoxic; thus, the incidence of HF has been increasing in this high-risk patient population. CRT has beneficial effects on morbidity, mortality, and left ventricular function in patients with non-ischemic cardiomyopathy, yet cancer patients and survivors who develop severe HF and are eligible for CRT often do not receive it.
Methods: Review of 2 years of echocardiography and electrocardiography data from cancer patients.
Results: Of 272 patients meeting inclusion criteria for CRT placement (LVEF ≤35%, QRS duration ≥120 ms), 131 (48.2%) had HF with ischemic etiology and 141 (51.8%) had HF with non-ischemic etiology. Most patients had solid tumors, including breast, lung, sarcoma, and lymphoma (73.2%, n=199). Only 21.3% (58/272; 27 ischemic; 31 non-ischemic) underwent CRT placement, who were mostly women and those with solid tumors. Non-ischemic HF was significantly associated with younger age (<65 years) (OR=0.91; 95% CI=0.87-0.95) and female sex (OR=2.5; 95% CI=1.1-6.0). As expected, ischemic HF was significantly associated with history of myocardial infarction, diabetes, and cardiovascular disease.
Conclusions: CRT is underutilized in cancer patients with HF. Most of the cancer patients who did not receive CRT had non-ischemic HF secondary to chemotherapy. CRT may be less utilized in those patients due to shortened life expectancy, yet evidence suggests that CRT has beneficial effects on morbidity, mortality, and left ventricular function. Its use may improve patient quality of life and allow oncologists to continue cancer treatments that could prolong survival.
Objective: Longer duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population.
Methods: We conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors.
Results: Mean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only.
Conclusions: These findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.
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