Racial differences in cardiovascular outcomes among cancer patients receiving immune checkpoint inhibitors.

Abstract

1613 Background: Immune checkpoint inhibitors (ICIs) increase the risk of major adverse cardiovascular events (MACE). We aimed to evaluate disparities in MACE across racial groups. Methods: We conducted a propensity score-matched study using the TriNetX Analytics Network database, which includes de-identified data from over 140 healthcare institutions. Adult cancer patients treated with ICIs were included and those with prior MACE were excluded. Patients were grouped into White, Black, Asian, and Hispanic cohorts. The primary outcome was incident MACE, defined as the composite of myocarditis, pericarditis, myocardial infarction, ischemic stroke, heart failure, atrial fibrillation, and venous thromboembolism (VTE) within 12 months of ICI. Matching was performed using variables: age, sex, cancer type, metastatic disease, comorbidities, and cardiovascular medication. Results: A total of 58,217 eligible patients were identified, including 44,151 White, 5,876 Black, 5,347 Asian, and 2,843 Hispanic individuals. After matching, cohorts were adequately balanced. Black patients had the highest risk for MACE, with an 18% increased risk compared to White (HR 1.18 [95% CI: 1.06-1.30]) and Hispanic patients (HR 1.18 [95% CI: 1.03-1.35]) and an 80% increased risk compared to Asian patients (HR 1.80 [95% CI: 1.57-1.35]). This increased risk among Black patients appeared to be driven by higher rates of heart failure and VTE. The risks of MACE were similar between White and Hispanic individuals while Asian patients had the lowest risk. Conclusions: There were racial differences in immune-related MACE, with Black patients experiencing the highest risk of cardiotoxicity following ICI treatment. Hazard ratio for effects of race on cardiovascular outcomes. Black vs. White Black vs. Hispanic Black vs. Asian White vs. Asian White vs. Hispanic Hispanic vs. Asian Outcomes n=5,109 each n=2,636 each n=3,095 each n=2,842 each n=4,876 each n=2,157 each MACE 1.18 (1.06-1.30) 1.18 (1.03-1.35) 1.80 (1.57-2.07) 1.44 (1.28-1.62) 0.98 (0.86-1.12) 1.60 (1.35-1.91) Myocarditis 0.50 (0.20-1.23) 0.16 (0.04-0.69) 0.61 (0.15-2.57) 1.85 (0.74-4.63) 1.08 (0.49-2.37) 1.66 (0.61-4.58) Pericarditis 1.10 (0.47-2.56) 1.36 (0.31-6.09) 2.31 (0.71-7.51) 2.99 (1.09-8.21) 1.20 (0.37-3.92) 0.99 (0.20-4.91) Myocardial infarction 1.09 (0.86-1.39) 1.18 (0.83-1.67) 1.80 (1.28-2.53) 1.42 (1.06-1.91) 1.18 (0.84-1.65) 1.47 (0.96-2.24) Ischemic stroke 1.23 (0.99-1.54) 1.13 (0.83-1.54) 1.34 (1.00-1.80) 1.17 (0.91-1.50) 0.81 (0.59-1.10) 1.45 (1.01-2.08) Heart failure 1.33 (1.11-1.61) 1.32 (1.01-1.73) 1.78 (1.37-2.31) 1.38 (1.10-1.73) 1.05 (0.80-1.39) 1.33 (0.96-1.84) Atrial fibrillation 0.96 (0.79-1.16) 1.19 (0.86-1.64) 1.29 (0.98-1.70) 1.36 (1.08-1.70) 1.26 (0.93-1.70) 0.95 (0.66-1.36) Venous thromboembolism 1.28 (1.12-1.47) 1.19 (1.00-1.41) 2.34 (1.92-2.84) 1.62 (1.37-1.91) 0.97 (0.81-1.15) 2.09 (1.63-2.69)