Burden and determinants of cardiovascular health and outcomes in patients with cancer

Chan, Shi Kai Jeffrey (2025) Burden and determinants of cardiovascular health and outcomes in patients with cancer. Doctoral thesis, University of East Anglia.

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Abstract

Introduction: Cardiovascular diseases in patient with cancer present an increasing health problem, the burden and determinants of which remains to be better understood.

Methods and results: First, using data of up to 37,882 individuals from the United States’ National Health Interview Survey, two cross-sectional studies demonstrated associations for social determinants of health and psychological distress with cardiovascular health in cancer survivors, and a prospective cohort study demonstrated independent associations between social determinants of health and cardiovascular mortality in these individuals. Then, using a cohort of up to 13,537 patients with prostate cancer receiving androgen deprivation therapy (ADT), five retrospective cohort studies were performed to quantify their cardiovascular burden and explore determinants of cardiovascular outcomes. Key findings included: 1) major adverse cardiovascular events (MACE) rose in incidence with patients having worse cardiometabolic profile over time despite declining mortality rates, 2) the number of major cardiac comorbidities may be more prognostic of cardiovascular outcomes than their types, 3) ADT worsened visit-to-visit HbA1c variability which was prognostic of MACE, and 4) gonadotropin-releasing hormone antagonists may have similar short-term risk but higher long-term risk of MACE compared to agonists. Lastly, using a cohort of up to 4324 patients with cancer receiving immune checkpoint inhibitors (ICI), a retrospective cohort study was performed to quantify their burden of MACE and cardiovascular hospitalizations, a self-controlled case series demonstrated transient short-term elevations in the risk of myocardial infarction following ICI use, and a retrospective cohort study demonstrated poor implementation of guideline-recommended pre-ICI initiation cardiometabolic workup, despite some improvements over time which did not improve cardiovascular outcomes.

Conclusions: Psychosocial factors, patient factors such as comorbidities, and cancer factors such as cancer therapies are all important determinants of cardiovascular outcomes in patients with cancer. Large gaps persist in these aspects of the cardio-oncology literature which remain to be explored.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	02 Oct 2025 08:58
Last Modified:	02 Oct 2025 08:58
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100586
DOI:

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