Black Patients at Increased Risk of Developing Chemotherapy-Related Cardiotoxicity

Black patients or patients of African ancestry have 71% greater odds of developing cardiotoxicity follow chemotherapy as their White counterparts, according to the results of a new study.

A systematic review wand meta-analysis of 2 dozen studies with more than 600,000 participants, results of the study underline the need for treatment options in this patient population, with Black patients or patients of African ancestry also having 92% greater odds if congestive heart failure after chemotherapy.

“Unfortunately, we were not surprised [by the findings]. Research shows that Black patients have poorer outcomes for almost every disease,” said lead investigator Wondewossen Gebeyehu, BSc, a medical student at the University of Toronto.² “In this case, one could have expected that the differences would be minimal since it is the chemotherapy that is injuring the heart, and we would expect the same chemotherapy to be given to Black and non-Black patients with a given cancer. However, this systematic review indicates that the inequities in health outcomes extends to the odds of cardiotoxicity after cancer treatment.”

Revelations surrounding the long-term cardiotoxicity of chemotherapeutic agents has resulted in the emergence of cardiooncology as a field. An example of the growing recognition of this field is the presentation of the STOP-CA trial as late-breaking data at the American College of Cardiology (ACC) 2023 annual meeting.³

In the current study, which was presented at ACC’s Advancing the Cardiovascular Care of the Oncology Patient 2023 conference, Gebeyehu, along with a team of colleagues from the University of Toronto and Harvard University, sought to explore racial disparities in the incidence of chemotherapy-induced cardio toxicity, citing a lack of systematically characterized evidence on the subject.¹

With this in mind, investigators designed their study as a systematic review and meta-analysis of data from the Medline, Embase, Pubmed, The Cochrane Database for Systematic Reviews, and Cochrane Central Register of Controlled Trials databases. Inclusion criteria established by investigators allowed for inclusion of studies of all designs reporting on cardiovascular events in cancer patients of different racial/ethnic backgrounds.¹

For the purpose of analysis, inverse variance weighting incorporating random effects was used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI) for outcomes for Black patients relative to White patients.¹

Overall, 7057 studies were identified for potential inclusion. Of these, 57 were sought for retrieval and assessed for eligibility. Ultimately, 24 studies were identified for inclusion. From these studies, investigators obtained data related to a cohort of 683,749 participants.¹

Among this cohort, the most commonly reported malignancy type was breast. Other common malignancy types included prostate, kidney, and hematological malignancies, such as leukemia and lymphoma. When examining treatment, agents used in these studies included anthracyclines, trastuzumab, and hormonal therapies.¹

Upon analysis, results indicated Black race or African ancestry was associated with 71% greater odds of chemotherapy-associated cardiotoxicity (unadjusted OR, 1.71 [95% CI, 1.40-2.10]; P <.00001). Further analysis indicated Black race or African ancestry was associated with 92% greater odds of chemotherapy-associated congestive heart failure than their White counterparts (unadjusted OR, 1.92 [95% CI, 1.68-2.19]; P <.00001).¹

“For clinicians, it is important to be aware of these higher odds of cardiotoxicity faced by Black patients. Understanding these disparities will hopefully lead to clinicians having more conversations around reducing cardiovascular risk associated with chemotherapy and targeted efforts to cater to groups at higher risk,” Gebeyehu added.²

References

1. Abdel-Qadir H, Gebeyehu W, Akioyamen L, et al. Racial Disparities in Cardiotoxicity After Cancer Treatment: Systematic Review and Meta-Analysis. Poster presented at: ACC Advancing the Cardiovascular Care of the Oncology Patient; April 14, 2023. Washington, DC. April 14, 2023
2. Black cancer patients 71% more likely to experience heart damage following chemotherapy treatment. American College of Cardiology. https://www.acc.org/About-ACC/Press-Releases/2023/04/14/13/46/Black-Cancer-Patients-71-More-Likely-to-Experience-Heart-Damage-Following-Chemotherapy-Treatment. Published April 14, 2023. Accessed April 14, 2023.
3. Iapoce C. Statins may help lessen effects of cardiac damage from Anthracyclines. HCP Live. https://www.hcplive.com/view/statins-help-lessen-effects-cardiac-damage-anthracyclines. Published March 4, 2023. Accessed April 14, 2023.