Abstract 980: Deaths from cardiovascular disease in rural and African American men with prostate cancer
Authors: Caroline Himbert, Heather M. Munro, Adam Bress, Philip W. Kantoff, Kenneth J. Mukamal, Martha J. Shrubsole, Konrad H. Stopsack
Journal: Cancer Research (2025)

Abstract Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality among men diagnosed prostate cancer. Different CVD risk factor profiles and disparities in healthcare access may place a higher burden on Black men and those living in rural areas diagnosed with prostate cancer. Methods: This cohort study aimed to evaluate differences in CVD deaths by rurality and race among men with prostate cancer. The Southern Community Cohort Study (SCCS) is a prospective cohort, which enrolled 34, 313 racially diverse, predominantly low-income men aged 40-79 in twelve southeastern states of the United States. Between 2002 and 2021, 1, 544 men with prostate cancer were free of prevalent CVD (i.e., coronary heart disease and stroke). Prostate cancer cases, vital status, and causes of death were identified through linkages to state cancer registries and the National Death Index as of December 31, 2022. Residence at enrollment was classified into rural and urban using community area codes. Lifetime risk for CVD death from Aalen-Johansen estimators and cause-specific hazard ratios (HRs) were computed. Results: 356 participants (23%) were classified as rural and 1, 174 (76%) self-identified as African American. Over 21 years of follow-up (median 8 years), 618 deaths occurred, of which 149 (24%) were from CVD. The lifetime risk of CVD death was similar comparing men with prostate cancer living in urban and rural areas at about 20%. After adjusting for sociodemographics, cancer, and CVD risk factors, the hazard ratio (HR) for rurality and CVD death was 0.95 (95% confidence interval (CI): 0.66, 1.40). African American men had a higher lifetime risk of CVD death (21%, 95% (CI): 16, 28) than White men with prostate cancer (16%, 95% CI: 11, 24). The cause-specific HR for CVD deaths was 1.36 (95% CI: 0.91, 2.04) in African American men compared to White men. African American men tended to be diagnosed with prostate cancer at a younger age (age adjusted HR: 1.68; 95% CI: 1, 12, 2.52). The association was attenuated upon adjustment for social determinants of health reflected in community health center enrollment (HR: 1.02; 95% CI: 0.66, 1.59) and was essentially unchanged after further adjustments (HR: 0.99, 95% CI: 0.63, 1.57). African American men with CVD risk factors at prostate cancer diagnosis (hypertension, diabetes, hypercholesteremia), lower education level, or no insurance or Medicaid/Medicare coverage were at the highest risk for CVD death. Conclusions: African American men with prostate cancer face a higher age-adjusted risk of death from CVD than White men with prostate cancer. This association could mainly be explained by racial differences in social determinants of health reflected in community health center enrollment. Integrating sociodemographic characteristics into treatment planning and prioritizing CVD prevention and management along prostate cancer care may reduce CVD mortality among men with prostate cancer. Citation Format: Caroline Himbert, Heather M. Munro, Adam Bress, Philip W. Kantoff, Kenneth J. Mukamal, Martha J. Shrubsole, Konrad H. Stopsack. Deaths from cardiovascular disease in rural and African American men with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 980.