by Elana Gotkine

Inequities in cardio-oncology care and research are addressed in a scientific statement issued by the American Heart Association and published online June 28 in Circulation.

Daniel Addison, M.D., from Ohio State University, and colleagues defined the current state of evidence relating to disparities in cardio-oncology and proposed an integrated approach to mitigate disparities in the routine clinical setting.

The authors note that women seem to have higher rates of immune checkpoint inhibitor-related toxicities, with some unique cardiotoxic mechanisms identified in women. The risk for cardiotoxicity and cardiovascular death with anticancer (targeted, immune, hormone) therapies is increased up to threefold for Black patients. Increased cardiotoxic risk is also seen in other racial and ethnic minority groups. Among Black patients, hypertension and other cardiovascular disease risk factors are disproportionately increased with chemotherapy.

Because many trials do not represent diverse populations well, caution should be exercised in interpretation of clinical trial data for cardiotoxic risk assessment. In cancer survivors, social determinants of health influence long-term cardiovascular risk and survival. Future directions for addressing cardio-oncology disparities include further investigation of sex-specific differences in cardiac toxicities, mechanisms underlying disparate cardiotoxic risk, strategies for improving representation in cancer clinical trials, and implementation of personalized cardioprotection strategies.

"Conscientiously leveraging technology and designing trials with outcomes related to these issues in practice (considering feasibility and cost) will critically accelerate the field of cardio-oncology in the 21st century. With tangible goals, we can improve health inequities in cardio-oncology," the authors write.

One author disclosed ties to the pharmaceutical industry.

More information: Daniel Addison et al, Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association, Circulation (2023). DOI: 10.1161/CIR.0000000000001158

Journal information: Circulation 

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