Cardio-oncology, the myth of Sisyphus, and cardiovascular disease in breast cancer survivors

Mavrogeni, Sophie; Sfendouraki, Elisa; Markousis‐Mavrogenis, George; Rigopoulos, Angelos; Noutsias, Michel; Kolovou, Genovefa; Angeli, Constantina; Tousoulis, Dimitrios

doi:10.1007/s10741-019-09805-1

Cited by 11 publications

(4 citation statements)

References 82 publications

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“…[2][3][4] In postmenopausal women with early-stage breast cancer, CV disease (CVD) has now surpassed cancer as the leading cause of mortality. 7 Additionally, in older populations among whom cancer is most prevalent, 8 comorbid CVD and risk factors may affect the way in which cancer can be managed without further complicating patients' health. 3,9 Cardio-oncology has emerged as a new subspecialty of medicine that provides a multidisciplinary approach, bringing together oncologists, cardiologists, and allied health care providers who are tasked with optimizing the CV health of patients exposed to potentially cardiotoxic cancer therapy.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Cardiovascular Health in Patients With Cancer: A Practical Review of Risk Assessment, Monitoring, and Prevention of Cancer Treatment–Related Cardiovascular Toxicity

Dent

Kikuchi

Kondapalli

et al. 2020

American Society of Clinical Oncology Educational Book

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Advances in cancer screening and improved treatment approaches have led to an increase in survivorship and, consequently, recognition of an association between cancer treatments and the development of cardiovascular complications. In addition, as the population becomes proportionally older, comorbid cardiovascular risk factors are more prevalent in the population and compound the risk of developing cancer treatment–related cardiovascular toxicity. Cardio-oncology has emerged as a new subspecialty of medicine that provides a multidisciplinary approach, bringing together oncologists, cardiologists, and allied health care providers who are tasked with optimizing the cardiovascular health of patients exposed to potentially cardiotoxic cancer therapy. Using a case-based approach, practical advice on how to identify, monitor, and treat patients with cancer who are at risk for developing cancer treatment–related cardiovascular dysfunction is discussed. Cardiovascular risk factors (e.g., age, hypertension, diabetes) and cancer therapies (chemotherapy, targeted therapy, radiation) associated with cardiovascular toxicity are presented. Current cardiac monitoring strategies such as two- and three-dimensional echocardiography, cardiac MRI, and biomarkers (troponin and brain natriuretic peptide [BNP]) are discussed. Last, the current literature on pharmacologic (e.g., angiotensin-converting enzyme inhibitors, β-blockers, statins) and lifestyle (diet and exercise) strategies to mitigate cardiovascular toxicity during and following completion of cancer therapy are reviewed.

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Section: Introductionmentioning

confidence: 99%

Optimizing Cardiovascular Health in Patients With Cancer: A Practical Review of Risk Assessment, Monitoring, and Prevention of Cancer Treatment–Related Cardiovascular Toxicity

Dent

Kikuchi

Kondapalli

et al. 2020

American Society of Clinical Oncology Educational Book

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“…Around 12% (123/1022) pediatric patients with acute myeloid leukemia were reported to suffer cardiotoxicity during and after the chemotherapy regimens over a five-year follow-up (8). In addition, cardiotoxicity would progress to congestive heart failure (CHF) and even cardiac death (5,9) and these complications have been the leading cause of long-term morbidity and mortality (10)(11)(12)(13). The incidence of CHF reported in patients treated with doxorubicin (DOX) was 2.2% (88/4018) (14) and the two-year mortality rate associated with anthracyclines-induced cardiovascular diseases (CVD) was up to 60% (15).…”

Section: Introductionmentioning

confidence: 99%

Can Dietary Nutrients Prevent Cancer Chemotherapy-Induced Cardiotoxicity? An Evidence Mapping of Human Studies and Animal Models

Zhang

Yang²,

Li³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionChemotherapy has significantly improved cancer survival rates at the cost of irreversible and frequent cardiovascular toxicity. As the main dose-dependent adverse effect, cardiotoxic effects not only limit the usage of chemotherapeutic agents, but also cause the high risk of severe poor prognoses for cancer survivors. Therefore, it is of great significance to seek more effective cardioprotective strategies. Some nutrients have been reported to diminish cardiac oxidative damage associated with chemotherapy. However, the currently available evidence is unclear, which requires a rigorous summary. As such, we conducted a systematic review of all available evidence and demonstrated whether nutrients derived from food could prevent cardiotoxicity caused by chemotherapy.MethodsWe searched Medline (via PubMed), Embase and the Cochrane Library from inception to Nov 9, 2021 to identify studies reporting dietary nutrients against cancer chemotherapy-related cardiotoxicity. We performed descriptive summaries on the included studies, and used forest plots to demonstrate the effects of various dietary nutrients.ResultsFifty-seven eligible studies were identified, involving 53 animal studies carried on rats or mice and four human studies in cancer patients. Seven types of dietary nutrients were recognized including polyphenols (mainly extracted from grapes, grape seeds, and tea), allicin (mainly extracted form garlic), lycopene (mainly extracted from tomatoes), polyunsaturated fatty acids, amino acids (mainly referring to glutamine), coenzyme Q10, and trace elements (mainly referring to zinc and selenium). Dietary nutrients ameliorated left ventricular dysfunctions and myocardial oxidative stress at varying degrees, which were caused by chemotherapy. The overall risk of bias of included studies was at moderate to high risk.ConclusionThe results indicated that dietary nutrients might be a potential strategy to protect cardiovascular system exposed to the chemotherapeutic agents, but more human studies are urged in this field.Systematic Review Registration:https://inplasy.com/inplasy-2022-3-0015/.

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“…Anthracycline is a primary chemotherapeutic agents with dose-dependent activity. Heart failure morbidity increases 5% when a cumulative dose of 400 mg/m 2 anthracycline is administered, and this rises to 16% with a dose of 500 mg/m 2 and 48% with a dose of 700 mg/m 2 ( 8 ). Trastuzumab, a humanized monoclonal antibody against HER-2 commonly used in early-stage breast cancer adjuvant treatment, is also reported to result in an unexpectedly high incidence of adverse cardiovascular events ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Can ACEI/ARB prevent the cardiotoxicity caused by chemotherapy in early-stage breast cancer?—a meta-analysis of randomized controlled trials

Hui¹,

Yao²,

Wang³

et al. 2020

Transl Cancer Res TCR

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Background: Administration of anthracycline-based chemotherapy with or without trastuzumab is recognized as standard care for breast cancer, but it is associated with a decline in left ventricular ejection fraction (LVEF). Angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) might decrease this cardiac dysfunction caused by the anti-cancer therapy. We sought to evaluate the prophylactic effects of the cardioprotective agents ACEI/ARB for early-stage breast cancer.Methods: We systematically searched the electronic databases Cochrane, PubMed, and Embase for randomized controlled trials (RCTs) evaluating the effect of ACEI/ARB. This meta-analysis calculated weighted mean differences with 95% CI, for ejection fraction and pooled odds ratios (OR) with 95% CI, for cardiac events. Pooled analyses were used in a random-effect model. The primary endpoint was the change of LVEF in the ACEI/ARB group versus the control group from baseline through completion of the studies.Results: our meta-analysis includes 5 studies encompassing 702 early-stage breast cancer patients. There was statistically significant diversity in the magnitude of the change of mean LVEF in patients receiving ACEI/ARB compared with control groups, with a mean difference of 4.08% (95% CI: 0.8% to 7.35%, P=0.01). However, regarding patient outcomes, ACEI/ARB did not significantly reduce the risk of cardiac events (OR 0.91, 95% CI: 0.62 to 1.34, P=0.64) or increase the incidence of hypotension events as compared with controls (OR 2.72, 95% CI: 0.69 to 10.73, P=0.15). Conclusions:Our study suggests that ACEI/ARB significantly attenuate the cardiac dysfunction caused by anthracycline-based chemotherapy and/or trastuzumab. Further studies are required to confirm the effectiveness of this cardioprotective agent.

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Cardio-oncology, the myth of Sisyphus, and cardiovascular disease in breast cancer survivors

Cited by 11 publications

References 82 publications

Optimizing Cardiovascular Health in Patients With Cancer: A Practical Review of Risk Assessment, Monitoring, and Prevention of Cancer Treatment–Related Cardiovascular Toxicity

Optimizing Cardiovascular Health in Patients With Cancer: A Practical Review of Risk Assessment, Monitoring, and Prevention of Cancer Treatment–Related Cardiovascular Toxicity

Can Dietary Nutrients Prevent Cancer Chemotherapy-Induced Cardiotoxicity? An Evidence Mapping of Human Studies and Animal Models

Can ACEI/ARB prevent the cardiotoxicity caused by chemotherapy in early-stage breast cancer?—a meta-analysis of randomized controlled trials

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