For many cancer patients, cardiovascular disease adds complexity to their treatment, although heart health may be the last thing on their minds. However, addressing the cardiovascular health of these individuals is equivalent to improving care and helping to avoid preventable cardiovascular disease in people already facing the challenges of an oncology diagnosis.
“It is estimated that one in three cancer patients who are going to receive some type of antineoplastic treatment will have some heart problem and cardiovascular complications,” says Dr. Raúl Córdoba, coordinator of the Lymphoma Unit of the Jiménez Díaz Foundationmember of the Cardio-Oncology Council of the European Society of Cardiology (ESC), representing the European Hematology Association (EHA), and co-director of CardioTox, the conference organized at the beginning of the month in Madrid by the European Society of Cardiology on the relationship between heart disease and oncology.
These complications can appear early, during treatment or once it has finished. In some cases, it may even take a few years to appear. Therefore, “it is very important to monitor and take care of cardiovascular health not only during the treatment of drugs such as chemotherapy, but also once they have finished it,” warns Doctor Córdoba.
How cancer treatments can affect the heart
The risk of heart problems during or after cancer treatment depends on the type and amount of medications or radiation received, as well as the health of the heart before starting treatment. According to this research published in European Heart Journal Based on analysis of more than three million cancer patients, approximately one in ten dies from cardiovascular disease, primarily heart disease.
There are several problems related to the heart and cancer treatments and there are also various cancer treatments that can damage the heart muscle and blood vessels, increasing the risk of developing heart disease over the days, weeks, months and even years after cancer treatment. This is what is known as cardiotoxicity related to cancer treatment.
Some cancer treatments, such as chemotherapies such as anthracyclines, which are used to treat a wide variety of common cancers, as well as tyrosine kinase inhibitors and immunotherapy, can affect the heart.
According to Córdoba, it has also been shown, in patients with hematological cancer, that “cell therapies with CAR-T lymphocytes and hematopoietic stem cell transplantation also increase the risk of long-term cardiovascular complications.”
Some medications block signals that allow cancer cells to grow, while others cause the immune system to destroy them. However, we are faced with drugs that not only attack cancer cells, but also healthy ones.
People can not only develop cardiac dysfunction, which is the most common complication and the one that prevents the heart from having enough strength to push all the blood once the heart is full, but also inflammation of the heart or myocarditis. Other complications derived from oncological treatments are arrhythmias, coronary heart disease and, therefore, acute myocardial infarctions and valvular heart disease—stiffness of the heart valves, which can stop working.
Active surveillance and periodic assessment: the keys to Cardio-Oncology
In most cases, replacing the medication that causes these effects is not possible. “We have a risk/benefit balance to be able to cure cancer without producing too many cardiovascular complications,” says Córdoba. In this sense, the doctor states that there are certain drugs from the same family that have a better cardiovascular safety profile and produce “less heart failure.” Although, in most cases, “we are going to have to look for strategies to protect the heart so that these drugs do not damage it and allow us to maintain the treatment.”
In this sense, active surveillance and periodic monitoring of cardiac function are key to detecting possible damage in early stages, which most of the time will not cause symptoms and which, fortunately, will be reversible.
In this sense, Córdoba clarifies that it is important that the cardio-oncological assessment be carried out at least three times: before starting cancer treatment to assess cardiovascular risk; during treatment, when it is essential to monitor cardiovascular health and how it reacts to drugs; and at the end of the process, after treatment, which is when a long-term cardiovascular health monitoring plan should be followed to “prevent and treat late complications,” says Córdoba.
A healthy lifestyle, the best prevention
What can the patient do to take care of the heart during cancer treatment? The key is prevention and adopting healthy lifestyle changes, such as exercising, eating a healthy diet and avoiding obesity, as well as avoiding tobacco and alcohol.
Reaching a cancer diagnosis with this low, without some of these risk factors, decreases or eliminates the risk of developing cardiovascular complications. If not, cardiologists can consider the use of cardioprotective drugs “to prevent damage to the heart,” says Córdoba.
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