Closing CVD Care Gaps in Early-Onset CRC: Meng-Han Tsai, PhD

In part 2 of her interview with The American Journal of Managed Care^®, Meng-Han Tsai, PhD, assistant professor at Augusta University, further discussed the findings of her study examining cardiovascular disease (CVD) mortality disparities among patients with early-onset colorectal cancer (CRC), defined as CRC diagnosed before age 50 years.

Among the study's most striking findings, the age-adjusted cardiovascular mortality rate in men was nearly 5 times that of women. Tsai attributed this gap to men's higher rates of chronic conditions before cancer diagnosis, which complicate treatment, as well as their generally lower engagement with health care compared with women.

She also addressed the role of treatment vs shared risk factors in driving CVD mortality. Although treatment can impact outcomes, she noted that pre-existing cardiometabolic risk factors likely play an equally important role. However, Tsai cautioned that she analyzed population-level data and that combining clinical and population-level data sources will be essential to fully understanding these relationships.

On the question of racial and ethnic disparities, she highlighted a counterintuitive finding: disparities were concentrated in urban rather than rural areas. Although urban areas are generally assumed to have more resources, Tsai explained that minority patients there still face significant barriers, including a lack of insurance, limited access to primary care, and medical mistrust.

American Indian and Alaska Native patients faced particularly stark disparities, with more than triple the CVD mortality risk of non-Hispanic White patients; she tied this finding to underrepresentation in research and a lack of culturally informed community engagement. To address these gaps, Tsai called for more comprehensive data combining clinical and population-level sources, as well as community-based research efforts designed to build trust with underrepresented populations and identify the specific barriers each group faces.

“Each time we look at the data, those racial minority groups are just so small, and then we have to combine them, so it is very difficult to really know which group has a particular barrier,” she said. “…we really need to think about how to explore these populations a little bit more.”

Looking ahead, she expressed hope that her findings will prompt health care systems to pay greater attention to younger patients with CRC and incorporate cardiovascular risk assessment into survivorship care planning, while further research works to confirm the role of pre-diagnosis risk factors in driving CVD mortality outcomes.