Breast cancer therapy-associated cardiovascular disease

Abstract

Breast cancer treatments have evolved over the past decades, although several widely used treatments have adverse cardiac effects. Radiotherapy generally improves the survival of women with breast cancer, although its deleterious cardiovascular effects pose competing risks of morbidity and/or mortality. In the past, radiation-associated cardiovascular disease was a phenomenon considered to take more than a decade to manifest, but newer research suggests that this latency is much shorter. Knowledge of coronary anatomy relative to the distribution of the delivered radiation dose has improved over time, and as a result, techniques have enabled this risk to be decreased. Studies continue to be performed to better understand, prevent and mitigate against radiation-associated cardiovascular disease. Treatments such as anthracyclines, which are a mainstay of chemotherapy for breast cancer, and newer targeted agents such as trastuzumab both have established risks of cardiotoxicity, which can limit their effectiveness and result in increased morbidity and/or mortality. Interest in whether β-blockers, statins and/or angiotensin-converting enzyme (ACE)-inhibitors might have therapeutic and/or preventative effects in these patients is currently increasing. This Review summarizes the incidence, risks and effects of treatment-induced cardiovascular disease in patients with breast cancer and describes strategies that might be used to minimize this risk.

MicroRNA-29b Regulates the Mitochondria-Dependent Apoptotic Pathway by Targeting Bax in Doxorubicin Cardiotoxicity

“…Cancer is the second leading cause of death worldwide [1]. Over the past decade, despite survival rates improving due to advances in cancer biology and therapeutics, immunosuppressive and cytotoxic adverse effects still limit the therapeutic use of anticancer drugs [1][2][3].…”

“…Over the past decade, despite survival rates improving due to advances in cancer biology and therapeutics, immunosuppressive and cytotoxic adverse effects still limit the therapeutic use of anticancer drugs [1][2][3]. Doxorubicin (Dox) is widely used for the treatment of solid tumors and hematologic malignancies [4,5].…”

Mitigating risk of cardiovascular disease in people living with and beyond cancer

“…Anti-hormonal therapies such as those used for breast and prostate cancer can have metabolic effects on testosterone or oestrogens causing an early menopause that can accelerate atheroma formation and result in ischaemic heart disease (Romo et al 2015, Zagar et al 2016 insulin levels, elevated total and low-density lipoprotein cholesterol, elevated triglycerides and decreased liver function. These are many of the components of metabolic syndrome, which increases long-term cardiovascular risk (Redig andMunshi 2010, Bourke et al 2012).…”

“…Although severe cardiotoxicity is relatively rare, as reported in clinical trials, analysis from large observational studies shows an increased risk of cardiovascular mortality in many patient groups; for some this is 10% to 30% greater than in age-matched controls (Curigliano et al 2010, Bourke et al 2012, Lenihan et al 2013, Suter and Ewer 2013, Kalsi et al 2014, Taylor and Kirby 2015. The reporting of cardiotoxicity varies across studies, partly because those who enter clinical trials are fitter and the short follow-up of many clinical trials compared with cumulative risk of observational studies reflects the wider risks of comorbidity (Cardinale et al 2016) (Table 1). Therefore, the prevalence of cardiotoxicity in a general cancer population is still relatively undefined.…”

Evaluation of QTc Interval Prolongation in Breast Cancer Patients after Treatment with Epirubicin, Cyclophosphamide, and Docetaxel and the Influence of Interobserver Variation

“…Cardiovascular toxicity has gained increasing attention as an adverse event in cancer treatment. Anthracyclines such as epirubicin can cause left ventricular dysfunction [2,3]. This has led to the regular testing of left ventricular ejection fraction (LVEF) by echocardiography for patients treated with anthracyclines [4].…”