Radiation-induced coronary artery disease: a difficult clinical conundrum

Abstract

Accelerated coronary artery disease seen following radiation exposure is termed 'radiation-induced coronary artery disease' (RICAD) and results from both the direct and indirect effects of radiation exposure. Long-term data are available from survivors of nuclear explosions and accidents, nuclear workers as well as from radiotherapy patients. The last group is, by far, the biggest cause of RICAD presentation.The incidence of RICAD continues to increase as cancer survival rates improve and it is now the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin's lymphoma and other mediastinal malignancies. RICAD will frequently present atypically or even asymptomatically with a latency period of at least 10 years after radiotherapy treatment. An awareness of RICAD, as a long-term complication of radiotherapy, is therefore essential for the cardiologist, oncologist and general medical physician alike.Prior cardiac risk factors, a higher radiation dose and a younger age at exposure seem to increase a patient's risk ratio of developing RICAD. Significant radiation exposure, therefore, requires a low threshold for screening for early diagnosis and timely intervention.

Myocardial Ischemia Related to Common Cancer Therapy—Prevention Insights

“…Firstly, the cardiovascular risk factors must be identified since they are important contributors to the progression of atherosclerosis and the onset of acute coronary events. This is of major concern since studies of cancer survivors beyond 5 years post-diagnosis have demonstrated a 1.7- to 18.5-times increased incidence of cardiovascular risk factors including hypertension, diabetes mellitus, and dyslipidemia when compared with age-matched counterparts without a history of cancer [ 193 ]. Lifestyle changes such as smoking cessation and exercise and pharmacological therapies are similar to those in the general population although some authors have proposed stricter targets [ 79 , 103 ].…”

Acute coronary syndromes in patients with cancer: Recent advances

“…Active malignancy, which is defined as a diagnosis within the previous 12 months or ongoing active cancer therapy including surgery, chemotherapy, or radiotherapy, is considered one of the major criteria for high bleeding risk, as outlined by the Academic Research Consortium for High Bleeding Risk [15,16]. In a study by Raposeiras-Roubin et al [17], 1 in 13 post-discharge bleeding events noted in ACS patients was associated with new cancer (positive predictive value for cancer diagnosis of post-discharge bleeding = 7.7%), affecting mainly the gastrointestinal, genitourinary, and bronchopulmonary systems [18]. Moreover, radiation-induced CAD (RICAD), which results from both direct and indirect effects of radiation exposure, is the second most frequent cause of morbidity and mortality among patients exposed to radiotherapy for breast cancer and Hodgkin lymphoma [16].…”

Forty years after mediastinal radiotherapy for Hodgkin lymphoma: how late is late cardiotoxicity? A case report

“… 1 Clinical features can be occult and may only develop with severe disease. 2 Whilst technological advancement in radiotherapy delivery and cardiac shielding has mitigated toxicity, there is a growing cohort of cancer survivors who will require vigilant, lifelong cardiac follow-up.…”