Incident cardiovascular disease risk among older Asian, Native Hawaiian and Pacific Islander liver cancer survivors

Background: Cardiovascular disease (CVD) is a significant global health concern, particularly among Asian, Native Hawaiian, and Pacific Islander (ANHPI) communities that face unique health challenges. Liver cancer disproportionately affects ANHPI populations and has intricate associations with CVD risks due to shared pathophysiological mechanisms and metabolic disturbances. However, the specific CVD risk profile of ANHPI liver cancer patients remains poorly understood. Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified and matched 1150 ANHPI and 2070 Non-Hispanic White (NHW) liver cancer patients diagnosed between 2000 and 2017. We used the Fine-Gray sub-distribution hazard model to estimate hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for CVD risks, including ischemic heart disease (IHD), heart failure, and stroke, among ANHPI liver cancer patients compared to NHW counterparts and among ANHPI subgroups. Results: ANHPI liver cancer patients demonstrated a lower risk of IHD compared to NHW counterparts (HR, 0.65, 95 % CI, 0.50, 0.86), aligning with broader trends. Subgroup analysis revealed notable heterogeneity within ANHPI populations, with Southeast Asian (HR, 0.65, 95 % CI, 0.42, 1.00) and Chinese patients (HR, 0.53, 95 % CI, 0.33-0.83) exhibiting lower IHD risks compared to their NHW counterparts. However, Native Hawaiian and Pacific Islander liver cancer patients showed elevated risks of heart failure (HR, 3.16, 95 % CI, 1.35-7.39) and IHD (HR, 5.64, 95 % CI, 2.19-14.53) compared to their Chinese counterparts. Conclusion: Our study highlights the complexity of CVD risks among ANHPI liver cancer patients. Addressing these disparities is crucial for improving cardiovascular outcomes and reducing the burden of CVD among ANHPI liver cancer patients.