Cancer Risk in the Heart Failure Population: Epidemiology, Mechanisms, and Clinical Implications

Cuomo, Alessandra; Pirozzi, Flora; Attanasio, Umberto; Franco, R. Lee; Elia, Francesco; Rosa, E. De; Russo, Michele; Ghigo, Alessandra; Ameri, Pietro; Tocchetti, Carlo G.; Mercurio, Valentina

doi:10.1007/s11912-020-00990-z

Cited by 15 publications

(24 citation statements)

References 105 publications

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“…Cancer patients have a high risk of venous thromboembolism, particularly cancer patients treated with pro-inflammatory drugs and radiotherapy (91,92). Therapy with anti-cancer drugs has also been associated with venous thromboembolism, which potentially could exacerbate the COVID-19-induced intravascular coagulative damages.…”

Section: Anti-cancer Drug-induced Cardiovascular Injury Might Increase Covid-19 Complication Risksmentioning

confidence: 99%

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Lozahic

Maddock

Sandhu

2021

Front. Cardiovasc. Med.

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Anti-cancer treatment regimens can lead to both acute- and long-term myocardial injury due to off-target effects. Besides, cancer patients and survivors are severely immunocompromised due to the harsh effect of anti-cancer therapy targeting the bone marrow cells. Cancer patients and survivors can therefore be potentially extremely clinically vulnerable and at risk from infectious diseases. The recent global outbreak of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its infection called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide health emergency, and on March 11, 2020, COVID-19 was declared a global pandemic by the World Health Organization (WHO). A high fatality rate has been reported in COVID-19 patients suffering from underlying cardiovascular diseases. This highlights the critical and crucial aspect of monitoring cancer patients and survivors for potential cardiovascular complications during this unprecedented health crisis involving the progressive worldwide spread of COVID-19. COVID-19 is primarily a respiratory disease; however, COVID-19 has shown cardiac injury symptoms similar to the cardiotoxicity associated with anti-cancer therapy, including arrhythmia, myocardial injury and infarction, and heart failure. Due to the significant prevalence of micro- and macro-emboli and damaged vessels, clinicians worldwide have begun to consider whether COVID-19 may in fact be as much a vascular disease as a respiratory disease. However, the underlying mechanisms and pathways facilitating the COVID-19-induced cardiac injury in cancer and non-cancer patients remain unclear. Investigations into whether COVID-19 cardiac injury and anti-cancer drug-induced cardiac injury in cancer patients and survivors might synergistically increase the cardiovascular complications and comorbidity risk through a “two-hit” model are needed. Identification of cardiac injury mechanisms and pathways associated with COVID-19 development overlapping with anti-cancer therapy could help clinicians to allow a more optimized prognosis and treatment of cancer survivors suffering from COVID-19. The following review will focus on summarizing the harmful cardiovascular risk of COVID-19 in cancer patients and survivors treated with an anti-cancer drug. This review will improve the knowledge of COVID-19 impact in the field of cardio-oncology and potentially improve the outcome of patients.

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Section: Anti-cancer Drug-induced Cardiovascular Injury Might Increase Covid-19 Complication Risksmentioning

confidence: 99%

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Lozahic

Maddock

Sandhu

2021

Front. Cardiovasc. Med.

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“…Importantly, symptoms such as dyspnea and fatigue can occur in both HF and cancer and may be misinterpreted as signs of HF worsening, procrastinating tumor diagnosis. On the contrary, common medications used for HF treatment could unmask malignancy that would have otherwise been silent for long, for example, gastrointestinal cancer may bleed earlier in patients who are treated with anti-platelet or anticoagulant drugs, commonly used for atrial fibrillation (AFib) or post-ischemic patients, both commonly associated with HF [3]. Indeed, in a recent manuscript, the authors evaluated the association between positive stool test for occult blood (fecal immunochemical test, FIT) and development of cardiovascular diseases, using the National Health Insurance database.…”

Section: Epidemiologymentioning

confidence: 99%

“…Moreover, when needed, it is also crucial to treat valvular defects or residual myocardial ischemia. Unfortunately, optimization and up-titration of cardiological therapy may require weeks or even months, and this could represent a significant problem in the management of cancer patients, especially if this delays the beginning of oncologic treatments [1,3,66]. Furthermore, the correction of other conditions that may increase cardiotoxicity, such as metabolic and electrolyte alterations, is also important to prepare patients to better face future oncological treatments [54•, 55•, 56].…”

Section: Clinical Management Of Hf Patients Who Develop Cancermentioning

confidence: 99%

“…It is critical to schedule regular follow-ups for HF patients during antineoplastic treatments, to early detect any sign of cardiotoxicity or serum alterations and quickly correct them, avoiding, when possible, the interruption of oncological treatments [1,3].…”

Section: Clinical Management Of Hf Patients Who Develop Cancermentioning

confidence: 99%

“…In recent years, cardio-oncology has substantially expanded, considering that new challenges rise from recent evidence that patients with HF have an increased risk of developing cancer, offering a new challenge to clinicians in terms of clinical and therapeutical management. In particular, this highlights the need to enhance the awareness on the relationship between cancer and HF and the mechanisms underlying it, in order to optimize the management and treatment of patients who present with both pathologies [3,4].…”

Section: Introductionmentioning

confidence: 99%

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New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management

Cuomo

Paudice

D’Angelo

et al. 2021

Curr Heart Fail Rep

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Purpose of Review Oncological treatments are known to induce cardiac toxicity, but the impact of new-onset cancer in patients with pre-existing HF remains unknown. This review focuses on the epidemiology, pathophysiological mechanisms, and clinical implications of HF patients who develop malignancies. Recent Findings Novel findings suggest that HF and cancer, beside common risk factors, are deeply linked by shared pathophysiological mechanisms. In particular, HF itself may enhance carcinogenesis by producing pro-inflammatory cytokines, and it has been suggested that neurohormonal activation, commonly associated with the failing heart, might play a pivotal role in promoting neoplastic transformation. Summary The risk of malignancies seems to be higher in HF patients compared to the general population, probably due to shared risk factors and common pathophysiological pathways. Additionally, management of these patients represents a challenge for clinicians, considering that the co-existence of these diseases significantly worsens patients’ prognosis and negatively affects therapeutic options for both diseases.

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Impact of a cardio‐oncology unit on prevention of cardiovascular events in cancer patients

et al. 2022

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AimsAs the world population grows older, the co-existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio-Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications. Methods and resultsWe enrolled 231 consecutive patients referred to our Cardio-Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month-survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow-up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04). Conclusions Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments.

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Cancer Risk in the Heart Failure Population: Epidemiology, Mechanisms, and Clinical Implications

Cited by 15 publications

References 105 publications

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management

Impact of a cardio‐oncology unit on prevention of cardiovascular events in cancer patients

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