Cardiovascular disease in cancer survivors

Abstract

Certain cancer therapies, including radiation therapy and some types of chemotherapies, are associated with increased risk of cardiovascular disease (CVD) and events. Some of these effects such as those presented by anthracyclines, radiation therapy, cisplatin, as well as those presented by hormone therapy for breast cancerusually taken for many years for some breast and prostate cancers-are long-lasting and associated with cardiovascular events risk more than 20 years after cancer treatment. Cardiovascular testing, diagnostic assessment of suspected cardiovascular symptomatology, as well as laboratory tests for CVD risk factors are imperative. The early recognition and treatment of CVD processes that arise in survivorship years is pivotal, with specific attention to some CVD processes with specific suggested treatment modalities. Preventive measures include adequate screening, the use of medications such as ACE inhibitors/angiotensin receptor blockers and/or beta blockers, statin therapy and aspirin in persons who warrant these medications, as well as therapeutic lifestyle modifications such as exercise/physical activity, weight loss and appropriate diet for a healthy lifestyle. Periodic follow-up with a good primary care physician who understands the risks associated with cancer therapy is important, and referral to onco-cardiology for further management of cardiovascular risk in these survivors is based on a patient's cardiovascular risk level and the type, amount and duration of cancer therapies received during the patient's lifetime.

Oxidative Stress in Radiation-Induced Cardiotoxicity

“…Radiation-induced CVDs can include pericardial disease, coronary artery disease, valvular heart disease, conduction disease, and cardiomyopathy [8,13]. Heart disease caused by radiotherapy develops slowly and occurs 20-30 years after radiotherapy [24].…”

“…These enzymes catalyze the transfer of electrons from NADPH to oxygen molecules to produce oxygen free radicals [23]. In addition, the late effects of radiation therapy are caused by the ionization of water molecules in the surrounding environment and the generation of chronic free radicals induced by radiation [24]. Radiation can not only change the upstream source of ROS but also change the balance of endogenous antioxidant defense mechanisms, including glutathione, ascorbic acid, catalase, and superoxide dismutase (SOD) [25].…”

Long-Term and Latent Side Effects of Specific Cancer Types

“…5 Cardiovascular complications can include hypertension, arrhythmias, coronary artery disease, heart failure, valvular disease, thromboembolic disorders, peripheral vascular disease, stroke, pulmonary hypertension, and pericardial complications. 6 Anthracycline-induced dose-dependent cardiotoxicity has been observed in 9% of adult patients, with the highest incidence in the first year after chemotherapy completion.…”

Out of the frying pan and into the fire: damage-associated molecular patterns and cardiovascular toxicity following cancer therapy

“…), they also promote other life-threatening complications, including cardiovascular disease. 3,26 Nonetheless, the mechanisms underlying cancer therapy-induced cardiotoxicity remain relatively unexplored.…”

“…2 One such problem is cardiovascular complications, which is the second leading cause of death in cancer survivors, only after cancer recurrence, cancer progression, and secondary malignancies. 3 In fact, cardiovascular complications have become so prominent that a new area of research is emerging within both cardiology and oncology to prevent and treat cancer therapy-induced cardiotoxicity; this field is referred to as cardio-oncology.…”