Abstract 13090: Racial and Ethnic Differences in Anthracycline Cardiotoxicity

Abstract

Background: There are limited data on anthracycline cardiotoxicity in racially and ethnically diverse populations. Therefore, our study sought to examine incident heart failure (HF) in cancer survivors treated with anthracycline in a multiracial community. Methods: We included consecutive adult patients who underwent anthracycline-based chemotherapy in 2016 and 2019 for any types of cancer at a single academic health system that serves a large multiracial community. Patients with preexisting HF were excluded. The end point was new development of clinical HF (ascertained by ICD-9 or 10 codes). Multivariable Cox proportional hazards models, adjusting for demographics, cardiovascular risk factors and anthracycline dose, were performed. Results: Our cohort studied 1,084 patients, including 21% Non-Hispanic White (NHW), 24% Non-Hispanic Blacks (NHB), 32% Hispanics and 2% Asians (Figure 1A). Mean age of the cohort was 58 ± 15 years, with 66% women. Hypertension, diabetes and hyperlipidemia were more prevalent in NHB, Hispanics and Asians than in NHW. Socioeconomic status score of NHB (-2.8 ± 2.7), Hispanics (-3.8 ± 2.8) and Asians (-2.0 ± 2.5) was significantly lower than NHW (0.1 ± 2.1, p<0.001). Mean cumulative anthracycline dose was 321 ± 205mg/m 2 and it was similar across groups. During median follow-up of 15 months, 113 patients developed HF. The cumulative incidence of HF was 11% in the entire cohort, with 6% in NHW, 12% in NHB, 11% in Hispanics and 23% in Asians (Figure 1B, p=0.055). Asian race (HR 3.8, 95%CI 1.3-11.5, p=0.016) and increased age (HR 1.02, 95%CI 1.01- 1.04, p=0.023) were significantly associated with incident HF. NH Black (HR 1.5, 95%CI 0.8-3.1) and Hispanic (HR 1.3, 95%CI 0.7-2.7) groups did not reach significance in multivariable adjusted analysis. Conclusions: In a large cohort of multiracial cancer survivors treated anthracycline-based chemotherapy, a higher incidence of clinical HF was identified in NHB, Hispanics and Asians compared with NHW.