Key result
Asian and Pacific Islander breast cancer survivors face ~28% lower incident heart failure risk vs. NHW survivors.
Why the study?
The risk of cardiovascular disease among Asian, Native Hawaiian and Pacific Islander breast cancer survivors in the United States was unknown.
Does the risk of incident cardiovascular disease differ between Asian, Native Hawaiian and Pacific Islander (ANHPI) and Non-Hispanic White breast cancer survivors?
Cohort (n=28,487)
Yes
Does the risk of incident cardiovascular disease differ between Asian, Native Hawaiian and Pacific Islander (ANHPI) and Non-Hispanic White breast cancer survivors?
While ANHPI breast cancer survivors generally have a lower risk of incident heart failure and ischemic heart disease compared to NHW survivors, significant heterogeneity exists, with Filipino, Asian Indian/Pakistani, and Native Hawaiian survivors facing higher risks.
May inform ethnicity-specific CVD risk counseling in breast cancer survivors; leaves open prospective validation and subgroup differences.
BACKGROUND: Cardiotoxicity among breast cancer survivors is associated with chemotherapy and radiation therapy. The risk of cardiovascular disease (CVD) among Asian, Native Hawaiian and Pacific Islander (ANHPI) breast cancer survivors in the United States is unknown. METHODS: We used the SEER-Medicare linked database to estimate the risk of CVD among older breast cancer survivors. International Classification of Disease diagnosis codes were used to identify incident CVD outcomes. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CI) comparing ANHPI with Non-Hispanic White (NHW) patients with breast cancer for CVD, and among ANHPI race and ethnicity groups. RESULTS: A total of 7,122 ANHPI breast cancer survivors and 21,365 NHW breast cancer survivors were identified. The risks of incident heart failure and ischemic heart disease were lower among ANHPI compared with NHW breast cancer survivors (HRheart failure, 0.72; 95% CI, 0.61-0.84; HRheart disease, 0.74; 95% CI, 0.63-0.88). Compared with Japanese patients with breast cancer, Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer survivors had higher risks of heart failure. ischemic heart disease and death. Among ANHPI breast cancer survivors, risk factors for heart failure included older age, higher comorbidity score, distant cancer stage and chemotherapy. CONCLUSIONS: Our results support heterogeneity in CVD outcomes among breast cancer survivors among ANHPI race and ethnicity groups. Further research is needed to elucidate the disparities experienced among ANHPI breast cancer survivors. IMPACT: Filipino, Asian Indian and Pakistani, and Native Hawaiian patients with breast cancer had higher risks of heart failure, ischemic heart disease and death among ANHPI patients with breast cancer.
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Hashibe et al. (2023) conducted a cohort in Breast Cancer (n=28,487). Asian, Native Hawaiian and Pacific Islander (ANHPI) race and ethnicity vs. Non-Hispanic White (NHW) race and ethnicity was evaluated on Incident heart failure (HR 0.72, 95% CI 0.61-0.84). Older Asian, Native Hawaiian, and Pacific Islander breast cancer survivors had a lower risk of incident heart failure (HR 0.72) and ischemic heart disease (HR 0.74) compared with Non-Hispanic White survivors.
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