Chinese Medical Journal study explores the risk of cardiovascular diseases in patients with cancer

Recent advances in cancer treatment have significantly reduced cancer-related deaths. However, cardiovascular diseases (CVDs) are emerging as a leading cause of hospitalization and death in cancer patients, particularly in aging populations. Shared risk factors like smoking, obesity, and sedentary lifestyles, combined with the cardiotoxic effects of chemotherapy and radiotherapy, contribute to this trend.

A recent study led by Professor Mamas A. Mamas from the University of Keele, United Kingdom, provides a detailed analysis of long-term CVD and their association with cancer patients. The review, published on issue 2, vol. 138  in the Chinese Medical Journal, highlights the importance of early diagnosis for cardiovascular-related risks in patients with cancer, helping to improve their quality of life. Further, the study emphasizes that cancer therapies, including chemotherapy and radiotherapy, often lead to cardiac complications such as heart failure, myocardial infarction, and arrhythmia. These risks are most pronounced during the first year after a cancer diagnosis and may persist for years.

According to Prof. Mamas, “Given the improved survival rates following a cancer diagnosis, patients with cancer are increasingly likely to have significant comorbidities such as CVD.” He further adds, “While cancer-specific mortality still accounts for the majority of overall mortality in patients with cancer, it is important to recognize that the risk of dying from CVD may surpass that of cancer.”

In older cancer survivors, CVD is more likely to become the primary cause of death than cancer itself. Studies show that cardiac complications such as blood clots, heart attacks, and heart failures can vary depending on the type and severity of cancer. To reduce the long-term risks of CVD, it is essential to monitor and manage heart health throughout the journey of cancer from its diagnosis to treatment and survival.

Existing health risk factors can increase the likelihood of cancer and CVD. Traditional treatments like chemotherapy and radiotherapy contribute to cardiotoxicity. Chemotherapy medications, even in lower dosages, are associated with heart failure. Additionally, radiotherapy damages adjoining tissues, causes arrhythmia in breast cancer patients, and poses a higher risk of heart-related deaths. Newer treatments, such as immunotherapy and stem cell therapy, have fewer side effects, but their long-term impacts on heart health remain to be explored.

“Morbidities caused by cancer are often of a transient nature and tend to improve after treatment discontinuation. However, some may persist and progress to chronic CVD if not detected and managed appropriately. Both traditional and newer cancer medications may increase the likelihood of developing diabetes,” explains Prof. Mamas.

Cancer and CVD share lifestyle risk factors such as alcohol, physical inactivity, obesity, smoking, and diabetes. Having one condition increases the risk of developing the others, and managing patients with both cancer and metabolic syndrome is challenging. Notably, up to 22% of cancer cases are associated with inflammation, which also plays a role in tumor formation. Both cancer and CVDs are influenced by platelets, which aid blood clotting. Cancer, for instance, can lead to abnormal clotting, which raises the risk of blood clots, heart attacks, and stroke.

Careful evaluation of cancer patients with CVD is essential, as certain cancer treatments can exacerbate heart conditions. The best time to plan for heart care is at the initial cancer diagnosis, allowing doctors to assess the risks and tailor treatments accordingly. This includes comprehensive health history assessments, early prevention strategies, and regular monitoring during and after cancer treatment. A collaborative cardio-oncology approach can address the complex relationship between cancer therapies and pre-existing CVDs, ultimately improving survival rates and quality of life.

Although cancer therapies have significantly increased survival rates, many patients remain at risk of CVDs—a primary health concern for most. For those with pre-existing heart conditions at the time of cancer diagnosis, the risk may persist for years after treatment. “Managing patients with cancer requires a comprehensive approach, particularly due to the diverse mechanisms through which anticancer therapies can cause cardiotoxicity. Identifying individuals at risk of cardiotoxicity is crucial for patient prognosis,” concludes Prof. Mamas.

Collaboration between oncologists and cardiologists is essential, as heart-related risks can overshadow cancer in shaping a patient's quality of life. By embracing a healthy lifestyle, individuals can protect both their hearts and succeed in their fight against cancer. As medical guidelines evolve, innovative research will pave the way for better strategies to safeguard lives and enhance well-being.

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Reference

Titles of original paper: Cardiovascular diseases in patients with cancer: A comprehensive review of epidemiological trends, cardiac complications, and prognostic implications

Journal: Chinese Medical Journal

DOI: 10.1097/CM9.0000000000003419