Cardiovascular Disease and Obesity Medications in Older Women by Obesity-Related Cancers Status: SEER-Medicare 2007–2015

Objective: This study evaluated the association between antiobesity medications (AOM) and incident cardiovascular disease (CVD) among older women, examining this relationship within and across survivors of obesity-related cancers (ORCa) and age-matched cancer-free populations. Methods: We conducted a retrospective cohort study using SEER–Medicare data from 2007 to 2015. The study included 46,552 women aged ≥ 65 years: ORCa survivors (n = 23,276) and age- and index-matched cancer-free women (n = 23,276). Prediagnostic AOM prescriptions before CVD onset were examined using intent-to-treat (ITT) and per-protocol approaches. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% CI for incident CVD. Results: In ITT analyses, AOM use was associated with lower CVD incidence in the composite analytic sample (HR = 0.80, 95% CI: 0.71–0.90) and among cancer-free women (HR = 0.70, 95% CI: 0.58–0.85). Among ORCa survivors, estimates suggested a similar direction but were not statistically significant. In per-protocol analyses, AOM use was associated with reduced CVD risk in ORCa survivors (HR = 0.74, 95% CI: 0.57–0.94) and cancer-free women (HR = 0.59, 95% CI: 0.45–0.77). These associations were more pronounced within the first 2 years of follow-up. Conclusions: AOM use was inversely associated with incident CVD among ORCa survivors and cancer-free women. Further studies of second-generation AOM, particularly glucagon-like peptide-1 receptor agonists, are warranted.