Cardiac Toxicities in the Era of Precision Medicine: Underlying Risk Factors, Targeted Therapies, and Cardiac Biomarkers

Abstract

Cancer therapies can cause a variety of cardiac toxicities, including ischemia, cardiomyopathy, heart failure, myocarditis, arrhythmias, vascular disease, hypertension, and hyperlipidemia. Addressing cardiovascular risk at baseline, before initiating therapy, during cancer treatment, and in the survivorship period is imperative. It may be useful to risk stratify individuals with cardiovascular risk factors using biomarkers or imaging before they receive potentially cardiotoxic therapies. Additionally, new guidelines recommend cardiac imaging with echocardiography in the survivorship period 6 to 12 months after completing cancer therapy for these high-risk individuals. Close collaboration between cardiology and oncology in both clinical practice and future research is essential.

Cardiac Complications in the Adult Bone Marrow Transplant Patient

“…Cancer and cardiovascular disease share overlapping risk factors, including behaviors, such as tobacco use and sedentary lifestyle, comorbidities, such as hypertension and diabetes, and processes, such as infection and inflammation [98]. The recent CANTOS trial, which investigated an antiinflammatory monoclonal antibody-canakinumab-which targets interleukin-1β, demonstrated both a reduction in cardiovascular events and a reduction in lung cancer-related mortality; these preliminary findings suggest that inflammation is a potentially significant contributor to development of both cardiac and oncologic disease states [99].…”

Preventive Cardio-Oncology: The Time Has Come

“…Radiation to the chest can result in accelerated atherosclerosis, pericardial disease, valve disease, conduction abnormalities, and cardiomyopathies (8)(9)(10). Traditional chemotherapies, endocrine therapies, and targeted or immunotherapies can also associate with these cardiovascular toxicities in addition to myocarditis (3,(11)(12)(13)(14)(15)(16)(17)(18), with valve disease possibly being no exception (19)(20)(21)(22).…”

“…Various chemotherapies and targeted or immunologic therapies can also lead to peripheral vascular toxicities, such as systemic hypertension, pulmonary hypertension, thrombosis, stenosis, vasospasm, or vasculitis (3,(11)(12)(13)(14)(15)(16)(17)(18) (Figure 1B). Systemic hypertension can further increase the risk of cardiovascular toxicity, as do all baseline CV risk factors (e.g., diabetes) and known CVD itself (11,17,23).…”

Treatment of heart failure in the patient with oncopatology

“…Одной из причин развития СН является токсическое воздействие на организм: прием алкоголя, отравление тяжелыми металлами, прием кардиотоксичных препаратов, лучевая терапия или радиация [5,6].…”

“…Использование некоторых антинеопластических препаратов (антрациклины, алкилирующие агенты, антитела) является доказанным этиологическим фактором различных токсических повреждений сердца, в том числе миокардитов, аритмий, кардиомиопатий. Их применение тесно связано с окислительным стрессом, дисфункцией митохондрий и двухцепочечными разрывами ДНК, что в свою очередь приводит к апоптозу и фиброзу кардиомиоцитов [6,7].…”