Abstract C092: Characterizing cardiovascular health by cancer survivorship using a novel AHA framework

Background: Cancer survivors are known to be at increased risk for cardiovascular disease (CVD), with CVD being the leading cause of death among those who survive 5+ years from their cancer diagnosis. While studies have compared cardiovascular events (e.g., MI, stroke) by cancer survivorship status, few have examined intermediary measures of cardiovascular health (CVH), which precede CVD events. The American Heart Association (AHA) adopted a novel framework called Life’s Essential 8 (LE8) to summarize the state of CVH. We utilized the AHA framework to assess the impact of cancer survivorship on CVH. Methods: We conducted a cross-sectional study using the national cohort of Reasons for Geographic and Racial Disparities in Stroke (REGARDS) study participants. The key explanatory variable was participants’ self-reported history of cancer (yes/no) in the baseline survey. The primary outcome of interest, LE8 score, was calculated by averaging 8 CVH domains: blood pressure (BP), body mass index (BMI), sleep, physical activity, diet, smoking habits, blood lipid and glucose levels. The overall LE8 score ranged from 0-100 with higher scores indicating better CVH. Consistent with AHA guidelines, we categorized the score into 3 groups: low (<50), moderate (50-79), and high (80+). We used multinomial logistic models to estimate associations between cancer history and CVH, adjusting for sociodemographic, medical factors and psychosocial factors including age, race, sex and history of heart disease. We conducted a multinomial logistic regression model for each LE8 domain score, separately. Results: We included 14,712 REGARDS participants, of whom 2,125 (14%) had a history of cancer and 12,587 (86%) had no history of cancer. Among individuals in the final analytic sample, 48% were female and 37 % were Non-Hispanic Black. The average age at baseline was 65 years (SD = 8) and 36% were college graduates. Participants with a history of cancer were more likely to be older (69 vs. 65), male (58% vs. 51%), Non-Hispanic White (74 % vs. 61%), have health insurance coverage (98% vs. 94%) and have a history of heart disease (23% vs. 18%). In our fully adjusted multinomial model, history of cancer was associated with 19% decreased odds of having poor CVH (OR = 0.81; 95% CI: 0.67–0.99; p = 0.037). In the fully adjusted model for individual LE8 domains, the association between cancer history and CVH was significant for cholesterol (OR 0.88; 95% CI: 0.79-0.99; p = 0.03) and glucose (OR 0.85; 95% CI: 0.75-0.97; p = 0.017) LE8 domains. Conclusions: In this large, national cohort, cancer survivorship was significantly associated with having better CVH according to the AHA’s LE8 framework. However, given the well-documented elevated CVD risk among cancer survivors, these findings may suggest that the AHA’s LE8 metric, created for the US general population, may not be capturing cancer-specific cardiotoxicity among cancer survivors. Thus, cancer-specific measures of CVH should be developed and considered. Citation Format: Rahma Ibrahim, Joanna B. Ringel, Han-Wei Wu, Stephanie D. Boone, Kelly Kenzik, Timothy B. Plante, Monika M. Safford, Laura C. Pinheiro. Characterizing cardiovascular health by cancer survivorship using a novel AHA framework [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C092.