Common Pathophysiology in Cancer, Atrial Fibrillation, Atherosclerosis, and Thrombosis

Leiva, Orly; AbdelHameid, Duaa; Connors, Jean M.; Cannon, Christopher P.; Bhatt, Deepak L.

doi:10.1016/j.jaccao.2021.08.011

Cited by 64 publications

(53 citation statements)

References 202 publications

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“…However, several scores (PRECISE-DAPT, PARIS) used to assess the risk and/or benefit of short vs long-term antiplatelet therapy after PCI have not been validated in patients with cancer [ 119 ]. The Academic Research Consortium for high bleeding risk (ARCHBR) criteria has been suggested for assessing the bleeding risk in this setting of patients [ 120 ].…”

Section: Discussionmentioning

confidence: 99%

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Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Lucà

Parrini²,

Abrignani

et al. 2022

JCM

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Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. Nonetheless, cancer patients have generally not been evaluated in ACS trials, so that the treatment in these cases is still not fully known. We reviewed the current literature and discussed the best management for these very high-risk patients. The treatment strategy must be tailored based on the cancer type and stage, balancing thrombotic and bleeding risks. When the prognosis is longer than six months, especially if a clinical instability coexists, patients with ACS and cancer should be referred for percutaneous coronary intervention (PCI) as soon as possible. Moreover, an invasive strategy should be preferred in STEMI patients as well as in NSTEMI patients who are considered as high risk. On the contrary, in clinically stable NSTEMI patients, a conservative non-invasive strategy could be adopted, especially in cases of a poor life expectancy and/or of high risk of bleeding. Drug-Eluting-Stents (DES) should be the first choice if an invasive strategy is adopted. Conservative therapy could instead be considered in cancer patients with more stable CAD at an increased risk of major bleeding complications. However, the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended, but it should be as short as possible, whereas triple antithrombotic therapy is non-advised because it significantly increases the risk of bleeding. ACS management among cancer patients should be based on an accurate evaluation of the risk of thrombosis and bleeding. Future studies focused on choosing optimal strategies in tumor patients with ACS should be performed to treat this subset of patients better.

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Section: Discussionmentioning

confidence: 99%

“…It also has been well assessed that in cancer patients, atrial fibrillation (AF) and CAD often coexist [ 119 ]. These two entities are often associated [ 121 ], and 10% of patients undergoing PCI for CAD have AF [ 122 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Lucà

Parrini²,

Abrignani

et al. 2022

JCM

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“…Inflammation, activated by cardiometabolic risk factors and comorbidities is further believed to hold a key role in the pathogenesis of atrial disease, a constellation of structural, electrical and functional atrial changes that underlies the development of AF ( 44 ). The production of reactive oxygen species (ROS), which are by-products of cellular metabolism and oxygen use and have been associated with an increased risk of cancer development via DNA damage and genetic destabilization ( 43 , 44 ), seems to be an important player in the association between inflammation on one hand and AF and cancer on the other ( 45 ). An increase in inflammatory markers such as C-reactive protein, tumour necrosis factor-a and interleukins 2, 6, and 8 has actually been found in patients with AF ( 3 ).…”

Section: Atrial Fibrillation In Cancermentioning

confidence: 99%

Anticoagulation for atrial fibrillation in active cancer (Review)

et al. 2022

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Atrial fibrillation (AF) may often pre-exist in patients with newly diagnosed cancer or occur with increased frequency shortly after cancer diagnosis. Patients with active cancer and AF have a particularly high risk of thromboembolic complications, as both conditions carry a risk of thrombosis. Thromboembolic risk is determined by several factors, including advanced age, sex (females), cancer histology (adenocarcinomas), location (e.g., pancreas, stomach), advanced stage, anticancer regimens (e.g., platinum compounds, anti-angiogenic therapies, immune modulators), comorbidities (e.g., obesity, kidney disease) and concurrent therapies (e.g., surgery, central catheters). Physicians are often reluctant to prescribe anticoagulants to patients with active cancer and AF, mainly due to fear of bleeding complications, which is partly related to the paucity of evidence in the field. Decision making regarding anticoagulation for the prevention of ischemic stroke and systemic embolism in patients with active cancer and AF may be challenging and should not simply rely on the risk prediction scores used in the general AF population. By contrast, the administration and choice of anticoagulants should be based on the comprehensive, individualized and periodic evaluation of thromboembolic and bleeding risk, drug-drug interactions, patient preferences and access to therapies.

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“…There is an association between atrial fibrillation (AF) and cancer, with inflammation contributing to the development of both in part through the production of reactive oxygen species. Elevation in C-reactive protein levels and increased NLRP3 inflammasome activation have also been reported in AF ( 46 ). Whether atrial fibrillation itself increases the risk of developing cancer requires further investigation.…”

Section: Introductionmentioning

confidence: 96%

Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure

Sinha

Bavishi

Hibler

et al. 2022

Front. Cardiovasc. Med.

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Breast cancer and heart failure share several known clinical cardiovascular risk factors, including age, obesity, glucose dysregulation, cholesterol dysregulation, hypertension, atrial fibrillation and inflammation. However, to fully comprehend the complex interplay between risk of breast cancer and heart failure, factors attributed to both biological and social determinants of health must be explored in risk-assessment. There are several social factors that impede implementation of prevention strategies and treatment for breast cancer and heart failure prevention, including socioeconomic status, neighborhood disadvantage, food insecurity, access to healthcare, and social isolation. A comprehensive approach to prevention of both breast cancer and heart failure must include assessment for both traditional clinical risk factors and social determinants of health in patients to address root causes of lifestyle and modifiable risk factors. In this review, we examine clinical and social determinants of health in breast cancer and heart failure that are necessary to consider in the design and implementation of effective prevention strategies that altogether reduce the risk of both chronic diseases

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Common Pathophysiology in Cancer, Atrial Fibrillation, Atherosclerosis, and Thrombosis

Cited by 64 publications

References 202 publications

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Anticoagulation for atrial fibrillation in active cancer (Review)

Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure

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