Cardiovascular Disease In Cancer Patients Research Articles

Cancer patients receiving immune checkpoint inhibitor therapy are at an increased risk for atherosclerotic cardiovascular disease

The widespread clinical use of immune checkpoint inhibitors (ICI) has increased our knowledge on their adverse effects on chronic inflammatory diseases. Atherosclerosis, a low-grade lipid-driven inflammatory disease of the larger...

Prevalence and prognosis significance of cardiovascular disease in cancer patients: a population-based study.

Background: Cardiovascular disease (CVD) is a heavy burden on cancer patients worldwide. This study aimed to evaluate the prevalence and influence of cardiovascular risk factors (CVRF) and CVD on the all-cause mortality among Chinese cancer patients.Results: Overall, 13.0% of all cancer patients had at least one type of CVRFs and 5.0% with CVDs. Patients with CVRF or CVD presented more frequently at later stages and received higher percentage of oncotherapy. During 1,782,527 person-years of follow-up, the all-cause mortality in cancer patients with CVDs and with CVRFs was higher compared with those without (182.6/1000, 109.5/1000 and 93.3/1000 person-years, respectively). Cox regression analysis showed that patients with heart failure (HR 1.79, 95% CI 1.61-1.99), myocardial infarction (HR 1.50, 95% CI 1.16-1.95), atrial fibrillation (HR 1.30, 95% CI 1.09-1.53), stroke (HR 1.21, 95% CI 1.11-1.32), hypertension (HR 1.10, 95% CI 1.04-1.16) and diabetes (HR 1.16, 95% CI 1.08-1.24) had increased all-cause mortality, whereas dyslipidemia patients had better prognosis (HR 0.73, 95% CI 0.64-0.83). Stratified by cancer type, the prognostic impact of specific CVRF or CVD varied.Methods: We consecutively recruited 710,170 cancer patients between Feb. 1995 and Jun. 2018. A stratified Cox proportional hazards model was used to analyze the effect of comorbidities on the overall survival of patients stratified by cancer type.Conclusions: Cancer patients are vulnerable to comorbidity related to heart and cerebral disease. The influence of comorbidities on prognosis is noticeable and specific both for the type of cancer and comorbidities.

The Impending Epidemic of Cardiovascular Diseases in Patients With Cancer in Japan.

Onco-cardiology, a new academic field, aims to improve the quality of life and prognosis of cancer patients and survivors with cardiovascular diseases (CVD). With the aging of the population, an epidemic of cancer with CVD is emerging in developed countries. Cancer and CVD share risk factors, pathophysiology, treatments, and preventive and rehabilitative measures. A multidisciplinary team-based approach is needed to support cancer treatment to maximize its effectiveness and minimize its cardiotoxic potential. Basic and clinical onco-cardiology are already being practiced harmoniously. However, systematization in academia and clinical practice and accumulation of evidence have just started. In this review, we present the epidemiology, common risk factors between cancer and CVD, future epidemic of CVD in patients with cancer, and the necessity for an onco-cardiological approach to managing the burden of CVD in cancer patients and survivors.

Leveraging the Cardio-Protective and Anticancer Properties of Resveratrol in Cardio-Oncology.

Cardio-oncology is a clinical/scientific discipline which aims to prevent and/or treat cardiovascular diseases in cancer patients. Although a large number of cancer treatments are known to cause cardiovascular toxicity, they are still widely used because they are highly effective. Unfortunately, therapeutic interventions to prevent and/or treat cancer treatment-induced cardiovascular toxicity have not been established yet. A major challenge for such interventions is to protect the cardiovascular system without compromising the therapeutic benefit of anticancer medications. Intriguingly, the polyphenolic natural compound resveratrol and its analogs have been shown in preclinical studies to protect against cancer treatment-induced cardiovascular toxicity. They have also been shown to possess significant anticancer properties on their own, and to enhance the anticancer effect of other cancer treatments. Thus, they hold significant promise to protect the cardiovascular system and fight the cancer at the same time. In this review, we will discuss the current knowledge regarding the cardio-protective and the anticancer properties of resveratrol and its analogs. Thereafter, we will discuss the challenges that face the clinical application of these agents. To conclude, we will highlight important gaps of knowledge and future research directions to accelerate the translation of these exciting preclinical findings to cancer patient care.

Cardiovascular diseases in cancer patients

Cardiovascular diseases in cancer patients

Methods of diagnosis in cardio-oncology

Early diagnosis and advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects. Cardiovascular diseases (CVDs) are one of the most frequent of these side effects. As a result of the direct effects of radiation therapy and chemotherapy on heart and vessels сan be: acceleration of atherosclerosis, damage of cardiomyocytes and endothelium, and arterial and venous thrombosis. The direct effect of the cancer treatment on the heart is called cardiotoxicity. Early diagnosis and identification of patients at high risk of cardiotoxicity is the first step towards successful prevention of CVD in cancer patients without compromising cancer care, which ultimately leads to a reduction in mortality. Echocardiography is the method of choice for the detection of myocardial dysfunction during and after cancer therapy. New methods of imaging like three-dimensional echocardiography, speckle-tracking echocardiography, cardiac magnetic resonance show a higher sensitivity in detecting of early myocardial dysfunction during cancer therapy. This review outlines the main diagnostic algorithms and approaches used in cardiooncology.

Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice.

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician’s awareness of the magnitude of the clinical problem of HF in cancer and the

Prediction of cardiovascular risk in cancer patients of South India using WHO/ISH risk prediction charts and Framingham score – A prospective study

Objective Despite the fact that cancer and heart diseases are interconnected, there is lack of information about the prevalence of cardiovascular risk in cancer patients in the South Indian population. With this background, the present study sought to predict the cardiovascular disease in cancer patients. Methods A prospective, cross-sectional study was conducted in the Department of Medical Oncology, Sri Ramachandra University and Hospital, India. Patients' demographic details, medical information, height, weight, body mass index, blood pressure, total cholesterol and HDL-cholesterol were measured. Two risk prediction tools, namely World Health Organization/International Society of hypertension (WHO/ISH) risk prediction charts and Framingham score were used to assess the prevalence of cardiovascular risk over 10 years. Results A total of 70 patients were included for the study. Breast and stomach cancer were found to be most among the study patients. Cardiovascular disease was assessed using WHO/ISH and Framingham risk assessment tool. With respect to WHO/ISH risk, there is a significant difference in gender, type of cancer, smoking status and age between the risk groups. Males have a high risk compared to females, and smokers have a high risk compared to non-smokers. With respect to Framingham score, there is a significant difference in gender, smoking status and systolic blood pressure between the risk groups. Males have a high risk compared to females, and smokers have a high risk compared to non-smokers. A moderate degree of agreement exists between the two risk prediction tools. Conclusion The findings of the study revealed that there is a low risk of cardiovascular disease in cancer patients.

Ischemic Heart Disease: Special Considerations in Cardio-Oncology.

The interplay and balance between the competing morbidity and mortality of cardiovascular diseases and cancer have a significant impact on both short- and long-term health outcomes of patients who survived cancer or are being treated for cancer. Ischemic heart disease in patients with cancer or caused by cancer therapy is a clinical problem of emerging importance. Prompt recognition and optimum management of ischemic heart disease mean that patients with cancer can successfully receive therapies to treat their malignancy and reduce morbidity and mortality due to cardiovascular disease. In this sense, the presence of cancer and cancer-related comorbidities (e.g., thrombocytopenia, propensity to bleed, thrombotic status) substantially complicates the management of cardiovascular diseases in cancer patients. In this review, we will summarize the current state of knowledge on the management strategies for ischemic disease in patients with cancer, focusing on the challenges encountered when addressing these complexities.

Substance P Prevents Vascular Endothelial Dysfunction in Metastatic Breast Carcinoma.

Recent studies document the importance of endothelial dysfunction (ED) in cancer development and metastasis. We previously reported that vascular oxidative stress and inflammation result in ED in animals bearing brain murine metastatic breast carcinoma (BCa). Substance P (SP), a neuropeptide found in sensory nerve terminals, was reported to enhance anti-tumoral effects of conventional treatments. SP was also reported to have anti-oxidative effects. We therefore examined the effects of continuous exposure to low dose SP on vascular ED observed in metastatic BCa. In this study, cells derived from brain metastasis of 4T1 murine BCa (denoted as 4TBM) were used. Female Balb-c mice 8-10 weeks old were divided into following groups: (1) Control (Hanks' balanced salt solution injected), (2) injected with 4TBM orthotopically, (3) injected with 4TBM orthotopically and then treated with SP via an osmotic mini-pumps (0.1 mM, pumping rate 0.11 μl/hr). Thoracic aorta was removed 20-26 days after injection of tumor cells. Isometric tension studies were performed in response to potassium chloride, phenylephrine, acetylcholine (an endothelium-dependent vasodilator), and sodium nitroprusside (an endothelium-independent vasodilator). On one hand, presence of tumor resulted in significant inhibition of vascular response to ACh in untreated mice. On the other, in vivo SP treatment restored the diminished relaxation response to ACh in thoracic aorta rings obtained from metastatic BCa bearing mice. These findings suggest that SP can inhibit tumor-induced ED which might be partly responsible from reported anti-tumoral effects of SP. Furthermore, protective effects of SP on vascular endothelium may prevent cardiovascular diseases in cancer patients.

The evolving field of cardio-oncology: beyond anthracyclines and heart failure.

Dr Michael Fradley discusses the cardiac implications beyond anthracyclines and heart failure Over the last several decades, the survival rates for many cancers have increased dramatically, largely driven by improved screening modalities and the development of novel cancer treatments including targeted and immunologic therapies. Despite these advancements, cardiovascular toxicity is a commonly observed complication of many of these treatments. As a result, the field of cardio-oncology has developed at a rapid pace. Cardio-oncology is a multidisciplinary specialty aimed at managing and preventing cardiovascular disease in cancer patients and survivors.1 Initially, cardio-oncology was focused on cardiomyopathy and congestive heart failure associated with anthracyclines, a class of chemotherapeutics used to treat a variety of cancers including breast, sarcoma, leukaemia, and lymphoma.2 As the field of cardio-oncology has grown, there is increased recognition that cardiotoxicity is not limited to just anthracyclines and heart failure; instead novel cancer therapeutics are associated with a variety of cardiac complications including vascular disease, accelerated hypertension, and arrhythmias. It is important for the cardio-oncologist to possess a broad knowledge of these agents and their toxicities in order to provide optimal care to patients. With improved understanding of cancer biology, the landscape of cancer therapeutics has changed dramatically. For example, abnormal cell signalling pathways have been implicated in many different cancers, often due to overexpressed or mutated protein kinases impacting the amino acid tyrosine.3 There is also data demonstrating that certain cancers are particularly dependent on proteasomes (multienzyme complexes that play a key role in protein degradation and homeostasis) for survival and proliferation.4 As such, the development of tyrosine kinase inhibitors (TKIs) and proteasome inhibitors (PIs), have led to significant improvements in the treatment of many liquid and solid tumours. More recently, immunomodulatory drugs (IMiDs) and other immunotherapies that harness the body’s own immune …

The Cardio-oncology Program: A Multidisciplinary Approach to the Care of Cancer Patients With Cardiovascular Disease

Improved cancer survivorship has resulted in a growing number of Canadians affected by cancer and cardiovascular disease. As a consequence, cardio-oncology programs are rapidly emerging to treat cancer patients with de novo and preexisting cardiovascular disease. The primary goal of a cardio-oncology program is to preserve cardiovascular health to allow the timely delivery of cancer therapy and achieve disease-free remission. Multidisciplinary programs in oncology and cardiology have been associated with enhanced patient well-being and improved clinical outcomes. Because of the complex needs of these multisystem patients, a similar model of care is gaining acceptance. The optimal composition of the cardio-oncology team will typically involve support from cardiology, oncology, and nursing. Depending on the clinical scenario, additional consultation from dietetics, pharmacy, and social services might be required. Timely access to consultation and testing is another prerequisite for cardio-oncology programs because delays in treating cardiac complications and nonadherence to prescribed cancer therapy are each associated with poor outcomes. Recommended reasons for referral to cardio-oncology programs include primary prevention for those at high risk for cardiotoxicity and the secondary treatment of new or worsening cardiovascular disease in cancer patients and survivors. Management is multifaceted and can involve lifestyle education, pharmacotherapy, enhanced cardiovascular surveillance, and support services, such as exercise training. The lack of evidence to guide clinical decisions and recommendations in cardio-oncology is a major challenge and opportunity for health care professionals. Large multicentre prospective registries are needed to adequately power risk model calculations and generate hypotheses for novel interventions.

Molecular Fingerprinting of Hsp27 Anti‐Apoptotic Activity

Apoptosis is an evolutionarily conserved mechanism crucial to the homeostasis of cell numbers, tissue development, and immune response. Several checkpoints regulate the activation of apoptosis, including heat shock protein 27 (Hsp27), an anti‐apoptotic regulator that blocks several steps in the apoptotic cascade. However, the structural basis for this protective effect remains unknown.Increased cardiomyocyte (CM) apoptosis contributes to cardiovascular disease (CVD) in doxorubicin (dox)‐treated cancer patients. CM apoptosis requires the activation of caspase‐3, a key evolutionarily conserved protease. We showed that Hsp27 associates with and inhibits caspase‐3, but the exact mechanisms remain unknown. The goal of this study was to determine the structural‐functional relationships responsible for the anti‐apoptotic activity of Hsp27. Serial deletion clones of Hsp27 were used to fingerprint the Hsp27 domains responsible for the association with caspase‐3 and inhibition of apoptosis. We identified different molecular signatures responsible for caspase‐3 association and the regulation of cytochrome c. These findings contribute to the understanding of Hsp27 anti‐apoptotic function and will aid in the development of anti‐apoptotic peptide therapies for the prevention of CVD in cancer patients.This research was funded by AHA SURF and ASC URS to JCT and RO1 HL075040 and NSF‐MCB 0542244 to AID

Early onset isolated ostial left-main-stem stenosis after breast cancer radiation report of a case and review of literature

Introduction: Radiation-therapy is an independent risk factor for cardiovascular disease in cancer patients. Isolated ostial stenosis after radiation-therapy is rarely reported and may form a new entity of radiation associated adverse event.

Cardiovascular disease in cancer patients… only the tip of the iceberg?

Cardiovascular disease in cancer patients… only the tip of the iceberg?

Treatment of cardiovascular diseases in cancer patients

Cardiovascular diseases and cancer are the leading causes of death in the Western world. Cancer treatment has been associated with cardiovascular complications, among others cardiotoxicity of mediastinal radiation and certain chemotherapeutics. Identification of patients at high risk, prevention, early diagnosis, and treatment of cardiovascular diseases are emerging fields in cancer patients. Close interdisciplinary work between oncologists and cardiologists is pertinent for the treatment of cardiovascular diseases and complications in cancer patients. Diagnostics and treatment applied to the individual case should be based on the available evidence in terms of patient-centered management. Further clinical research focused on the pathogenesis and treatment of cardiovascular diseases in cancer patients is warranted to pave the way to guidelines for this nonhomogeneous patient group.

Cancer and Cardiovascular Disease

Cancer and cardiovascular disease (CVD) are the two most common causes of mortality and morbidity worldwide. The incidence of both cancer and cardiovascular disease increases with age. With increased life expectancy, the burden of both these diseases will increase substantially over the next generation. Advancement in cancer therapy and supportive care has led to increasing number of survivors of childhood cancer. Seventy percent of the children diagnosed with malignancy before the age of 15 years will have a disease-free 5-year survival from diagnosis. Cancer is now being recognized as a chronic disease as evidenced by a growing number of cancer survivors that currently exceeds 11 million. With further improvement in cancer therapy, this number will likely increase in years to come. As the numbers of survivors grow so does the number of patients living with the late effects of cancer-related cardiotoxicity. Amongst Hodgkin lymphoma patients who have received radiation, CVD is one of the most common causes of death. Physicians and ancillary staff frequently have to take care of patients with concomitant cancer and cardiovascular disease. Some cardiac diseases predates the diagnosis of cancer, whereas other conditions like chemotherapy-induced cardiomyopathy and radiation-related heart disease are directly related to the cardiotoxic side effects of cancer therapy. The cardiotoxic side effects of agents like 5-fluouracil, adriamycin, and tyrosine kinase inhibitors are well known. However, the cardiotoxic profiles of newer investigational chemotherapeutic agents are largely unknown. Chemotherapy frequently induces thrombocytopenia, which in itself poses therapeutic challenge in the management of conditions like acute coronary syndrome, atrial fibrillation, stroke, and prosthetic valves. Evidence-based treatment of cardiovascular disease in cancer patients is lacking largely because all cardiology trials have excluded patients with cancer and similarly cancer trials have excluded patients with significant cardiovascular comorbidity. While recently some single-center studies have shown the efficacy of medications like ace inhibitors and beta blockers for the treatment of chemotherapy-induced cardiomyopathy, evidence-based treatment of other major cardiovascular diseases in cancer patients is not well established. In this issue of cancer and cardiovascular disease, we have covered some common conditions like venous thrombosis, cardiovascular effects of radiation therapy, cardiovascular effects of anthracycline in childhood cancer survivors, and management of aortic aneurysm in cancer patients. The use of newer modality, like computed tomographic angiography, may provide a pivotal role in the investigation of cancer patients with concomitant cardiac problem, as outlined in a clinical investigation in this journal. The case reports presented are some conditions that are unique to cancer population. Cardio-oncology is a growing field, and we are encouraged by the number of submissions to our special edition. We hope that the readers will find this special edition useful in their clinical practice. Syed Wamique Yusuf Carlo Cipolla Jean-Bernard Durand Daniel J. Lenihan

Therapy Insight: management of cardiovascular disease in patients with cancer and cardiac complications of cancer therapy

Cardiac disease in patients with cancer or caused by cancer therapy is a clinical problem of emerging importance. Optimum management of cardiovascular disease can mean that patients with cancer can successfully receive therapies to treat their malignancy and can reduce morbidity and mortality due to cardiovascular disease in cancer survivors. The presence of cancer and cancer-related morbidities substantially complicates the management of cardiovascular disease in cancer patients. In this Review, we discuss management strategies for cardiovascular disease in patients with cancer, focusing on the prevention and treatment of congestive heart failure and myocardial infarction.

The Diagnosis and Management of Cardiovascular Disease in Cancer Patients

Cardiovascular disease is commonly found in cancer patients. The co-existence of heart disease and cancer in a patient often complicates treatment, because therapy for one disease may negatively affect the outcome of the other disease. In addition, guidelines for the treatment of cardiovascular disease are often based on studies, which exclude patients who have cancer. In this review we will discuss the diagnosis and management of cardiovascular disease in cancer patients. We will focus on cancer-related causes of cardiovascular disease and special treatment options for cardiovascular disease in cancer patients. The cardiac complications of cancer therapy will be discussed according to common syndromes: left ventricular dysfunction, myocardial ischemia, blood pressure changes, thromboembolism, bradyarrhythmias, and prolonged QT interval.