Advisory Committee Chair
Sadeep Shrestha
Advisory Committee Members
Russel L Griffin
Carrie A Lenneman
Cora E Lewis
Lisle M Nabell
Document Type
Dissertation
Date of Award
2021
Degree Name by School
Doctor of Philosophy (PhD) School of Public Health
Abstract
The objective of my dissertation research was to assess burden of cardiovascular disease (CVD) risk factors in Head Neck Squamous Cell Carcinoma (HNSCC) patients and to determine the association of traditional CVD risk factors and HNSCC-related factors with incident CVD outcomes. For this clinical cohort study, I analyzed electronic medical records (EMR) and tumor registry data on HNSCC patients diagnosed between January 2012 and December 2018 at UAB hospital and O’Neal Comprehensive Cancer Center. First, I assessed prevalence and incidence of traditional CVD risk factors at HNSCC diagnosis (baseline) and at one-year post HNSCC diagnosis, respectively. Then I determined the association of traditional CVD risk factors and HNSCC-related factors with incident CVD events. For my first aim, I used logistic and robust Poisson regression models to report prevalence and incidence of traditional CVD risk factors (n=2,262). At baseline, prevalence of dyslipidemia was higher in white HNSCC patients than in blacks; the opposite was observed for diabetes. Black patients had lower odds of ≥1 prevalent CVD clinical risk factors. Rural patients had higher risk of incident diabetes at one-year, than urbanites. For my second and third aim, I did time-to-event analysis using accelerated failure time (AFT) models with death as competing risk. I reported association of traditional CVD risk factors and HNSCC-related factors with incident CVD. I included 1,829 patients without history of prior CVD at baseline. Outcome of interest was a composite of incident ischemic heart disease, heart failure, and ischemic stroke, whichever occurred first. While older age, prevalent dyslipidemia and diabetes were associated with increased risk of incident CVD at one and two-years, hypertensive medication use was associated with reduced CVD risk. Patients receiving HNSCC surgery had the highest short-term risk of incident CVD. Long-term CVD risk was high in patients receiving radiation-therapy and in human papillomavirus (HPV)-negative patients. HNSCC patients were at high risk of developing traditional CVD risk factors and CVD outcomes. While traditional CVD risk factors remained associated with incident CVD risk in HNSCC patients, HNSCC treatment and HPV-status also contributed to incident CVD risk. Routine screening and monitoring can reduce CVD burden in HNSCC patients.
Recommended Citation
Mukherjee, Amrita, "Cardiovascular Disease Risk in Head Neck Squamous Cell Carcinoma Patients: Using Electronic Medical Records Data" (2021). All ETDs from UAB. 546.
https://digitalcommons.library.uab.edu/etd-collection/546