Radiation-Induced Cardiovascular Disease

Abstract

Mediastinal radiation therapy accelerates the atherosclerosis process, resulting in early onset coronary artery disease. Valvular disease due to radiation therapy typically affects the left-sided valves, with aortic regurgitation being the most common. Rarely, it may lead to aortic stenosis requiring surgical interventions. Pericardial involvement includes acute and chronic pericardial disease and pericardial effusion. New studies are investigating the prevalence and pathogenesis of autonomic dysfunction in cancer survivors who have undergone mediastinal and neck radiation. Radiation therapy itself causes vascular endothelial dysfunction, resulting in clinical cardiovascular events, manifesting many years after completion of therapy. There remains little guidance regarding screening and therapies to prevent cardiovascular events in this population.

Oxidative Stress in Radiation-Induced Cardiotoxicity

“…The use of high doses of radiation in cancer treatment has been shown to damage heart tissue, leading to cardiac dysfunction and CVD [2]. 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].…”

“…Radiation-Induced Pericardial Disease. Pericardial disease is a common and classic complication of mediastinal radiotherapy; its types include acute pericarditis, pericardial effusion, delayed thickening, and constrictive pericarditis [13]. In a postmortem study, 20 cancer patients with a history of mediastinal radiotherapy were examined.…”

“…Thus, the inflammation state of atherosclerosis may again form a positive self-regulatory loop, forming proinflammatory and fibrotic environments, leading to tissue remodeling, myocardial fibrosis, and atherosclerosis. 7 Oxidative Medicine and Cellular Longevity these patients developed at different times and appeared three to five years after radiation [13]. Acute pericarditis usually occurs during radiotherapy or within a few weeks after radiotherapy, and the exudate is fibroid.…”

“…Echocardiography is still the golden standard for deterministic diagnosis [53]. Constrictive pericarditis is usually one of the most serious complications, and diuretics are usually the first line of defense; however, the final treatment is pericardiectomy [8,13].…”

“…Chest radiotherapy is used to effectively treat some malignant tumors, such as HL and breast cancer. However, the incidence of cardiovascular events in these patients has increased for years, especially among young survivors who do not have traditional risk factors [13]. Oxidative stress in cells is the main factor of CVD [14].…”