Abstract PO-139: Racial differences in ideal cardiovascular health and associations with racial disparities in cardiovascular disease among women with breast and gynecologic cancer
Authors: Sinnott Jennifer A. , Krok-Schoen Jessica L. , Arthur Elizabeth K. , Ridgway Emily , Gray Darrell M. , Williams Karen P. , Hood Darryl B. , Joseph Joshua J. , Felix Ashley S. , Nolan Timiya S. 
Published: December 2020

Abstract
BACKGROUND: Racial disparities in cardiovascular disease (CVD) incidence among cancer survivors exist, with Black women experiencing higher morbidity and mortality than White women. Ideal cardiovascular health (CVH), a composite measure of modifiable lifestyle behaviors and biometric factors, is inversely associated with CVD. However, the extent to which racial differences in ideal CVH drive CVD disparities among women with breast and gynecologic cancers is unknown. METHODS: We included 110 White and 283 Black women of the Southern Community Cohort Study (SCCS) and without CVD or cancer at baseline who subsequently developed a breast or gynecologic malignancy, and with data available to determine CVH. Incident cancer diagnoses were ascertained via linkage with state cancer registries. The main outcome, newly diagnosed fatal or non-fatal CVD, was ascertained via linkage of the SCCS cohort with the Centers for Medicare and Medicaid Services. We categorized ideal CVH using the American Heart Association’s Life Simple 7 (LS7) framework. Body mass index, glucose (presence/absence of diabetes or medication information), cholesterol (presence/absence of hypercholesterolemia or medication information), blood pressure (hypertension presence/absence or measurement if available), smoking history, diet quality, and physical activity were dichotomized as not ideal vs. ideal based on established LS7 cut points. The resulting seven point score was categorized as inadequate (0-2), intermediate (3-4), or ideal (5-7) CVH. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race, ideal CVH, and CVD incidence, adjusted for age at cancer diagnosis, SCCS enrollment year, type of cancer, and time from SCCS enrollment to cancer diagnosis. RESULTS: CVH was similar by race (p=0.90). There were also no significant differences in CVH by age at enrollment or cancer diagnosis, household income, insurance, or marital status. Women with ideal CVH were more likely to have more than a high school education than women with inadequate or intermediate CVH (p=0.03). In Cox models with incident CVD as the outcome when White women with intermediate CVH were the reference group, White women with inadequate CVH had similar CVD risk (HR=1.02) while those with ideal CVH had lower CVD risk, though not significant (HR=0.80, 95% CI 0.43-1.50). Black women with intermediate and ideal CVH had similar CVD risks as white women with intermediate CVH (HR=1.11 and HR=1.02, respectively), while Black women with poor CVH had significantly higher risk of CVD (HR=1.49, 95% CI 1.00-2.20). CONCLUSIONS: Black breast and gynecological cancer survivors, compared to White survivors, may experience elevated risk of CVD despite CVH status. Given that findings showed no differences in baseline characteristics between the Black and White survivors, further study of other potential confounders owing to the social determinants tied to the construct of race is warranted.
Citation Format: Jennifer A. Sinnott, Jessica L. Krok-Schoen, Elizabeth K. Arthur, Emily Ridgway, Darrell M. Gray, Karen P. Williams, Darryl B. Hood, Joshua J. Joseph, Ashley S. Felix, Timiya S. Nolan. Racial differences in ideal cardiovascular health and associations with racial disparities in cardiovascular disease among women with breast and gynecologic cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-139.