Temporal trends in cardiovascular mortality among ovarian cancer patients in the United States: A 22-year analysis of United States mortality data by age, race, and geographic region, 1999-2020.

Abstract

e17584 Background: Cardiovascular disease (CVD) represents a significant competing cause of death among ovarian cancer survivors, with survivors showing increased risk of heart failure compared to the general population. Temporal trends in CVD mortality remain poorly characterized but are critical for survivorship planning and risk stratification. We analyzed 22-year U.S. mortality data to evaluate trends by race, geographic region, age, and CVD subtype. Methods: We analyzed CDC WONDER database mortality data from 1999 to 2020 for ovarian cancer patients (ICD-10 code C56) with cardiovascular causes of death (ICD-10 codes I00-I99). Age-adjusted mortality rates (AAMR) per 100,000 populations were calculated using the US standard population. We used Joinpoint Regression Program to identify trends by race/ethnicity, US Census region, cardiovascular disease subtype, and ten-year age groups, with annual percent change (APC) calculated for each variable. American Indian/Alaska Native excluded from racial analyses due to insufficient data. Results: We identified 77,499 cardiovascular deaths with comorbid ovarian cancer. The AAMR decreased from 3.44 (95% CI [3.33–3.56]) in 1999 to 2.59 (95% CI [2.51–2.68]) in 2020, representing a 24.7% reduction. The three most common CVD causes were other forms of heart disease (64.6%), hypertensive disease (25.4%), and ischemic heart disease (16.9%). Joinpoint analysis revealed significant decreases for most CVD subtypes: ischemic heart disease (APC -5.13, 2003-2020, p<0.05), other forms of heart disease (APC -2.89, 1999-2018, p<0.05), and cerebrovascular disease (APC -4.06, 1999-2016, p<0.05), except hypertensive diseases which increased after 2018 (APC +10.03, p<0.05). Mortality was concentrated in older age groups (75-84 years: 9.58 to 6.69 per 100,000; 85+ years: 13.84 to 9.49). Black or African American patients showed steady decline (APC -2.39, p<0.05) with AAMR decreasing from 2.45 (95% CI [2.20–2.70]) to 1.60 (95% CI [1.45–1.75]), while White patients had accelerated decline post-2006 (APC -3.16, p<0.05). The Northeast had highest initial AAMR at 2.64 (95% CI [2.47–2.80]) with most rapid decline during 2007-2012 (APC -6.35, p<0.05). Racial and geographic disparities narrowed considerably. Conclusions: Cardiovascular mortality among ovarian cancer patients declined significantly over 22 years with substantial narrowing of disparities. However, recent dramatic increases in hypertensive disease mortality warrant enhanced blood pressure management in survivorship care programs. Integrating cardiovascular risk mitigation into ovarian cancer follow-up may further improve outcomes.