Cardiovascular prevention in the cancer survivor

Cardiovascular Screening and Lipid Management in Breast Cancer Survivors

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death among breast cancer (BC) survivors. BC survivors are at increased risk of CVD due to a higher prevalence of risk factors. Current data are limited on the cardiovascular screening practices and lipid management in this population in primary care settings.

METHODS

A retrospective case control study was performed with 105 BC survivors and 210 matched controls (based on age and medical comorbidities of diabetes, hypertension, and hyperlipidemia). BC survivors were established with primary care practices within a large academic institution and had completed primary cancer treatment. Data on screening for CVD and lipid management were collected via a retrospective chart review.

RESULTS

The average BC survivor was 63 years old, with 9 years since diagnosis. Compared with matched controls, BC survivors had more cholesterol screening (88% vs 70%, P < .001) and active statin prescriptions (63% vs 40%, P < .05) if indicated by the Atherosclerotic Cardiovascular Disease Calculator. There were no differences in CVD screening in White and African American BC survivors. However, African American BC survivors were more likely to have hypertension (P < .01) and have a body mass index in the overweight and obese category (P < .001) than White BC survivors. Older BC survivors were more likely to receive cholesterol screening.

DISCUSSION

This study demonstrates that BC survivors who have an established primary care provider have improved cholesterol screening and statin therapy based on their risk of developing chronic diseases.

Air Pollution across the Cancer Continuum: Extending Our Understanding of the Relationship between Environmental Exposures and Cancer

Previous studies of the environment and cancer have focused on etiology, showing that extrinsic factors in the environment contribute to 70% to 90% of cancers. Cancer patients and survivors often continue to live in the same neighborhoods they resided in before their cancer diagnosis. Thus, patients and survivors are exposed to the same environmental contexts that likely contributed to their original cancer, but little is known about the health effects of continued exposure to carcinogens after a cancer diagnosis. This commentary provides a summary of studies of the association between PM_2.5 and cancer mortality among patients and PM_2.5 and posttreatment morbidity among cancer survivors, and proposes new directions and opportunities for future research on such topics.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

Association between cardiovascular disease and a history of cancer in patients with chest pain on the fast track outpatient clinic

Background

The purpose of this study is to investigate the prevalence of a history of malignancy in patients with chest pain who were referred for computed tomography angiography as well as the long-term survival and cardiovascular outcomes, including coronary artery disease (CAD) and coronary artery calcium (CAC) percentiles of cancer survivors. These data are relevant since it is unknown how cancer survivors, who underwent cardio-toxic therapies, should be monitored.

Methods

We analysed all patients with chest pain, who came to the outpatient clinic and underwent computed tomography angiography. The primary study endpoint was long-term survival. The secondary endpoints included CAD on computed tomography angiogram (CTA), CAC percentiles, suspected and confirmed malignancy on CTA, and other accidental findings on CTA.

Results

Of all 1,892 patients included in the analyses, 133 (7%) had a history of malignancy and 1,759 (93%) did not. Mortality rates were higher for the cancer survivors (6.5% vs 20.9% after ten years, p < 0.001). The multivariable Cox regression model also showed higher mortality for cancer survivors after ten years (adjusted hazard ratio 2.48 [95% confidence interval: 1.58–3.90]). CAD did not differ between both groups. CAC percentiles were higher in cancer survivors (p = 0.037). Cancer survivors had more suspected malignancies (3.8% vs 0.5%; p = 0.001) and also more confirmed malignancies on CTA (3.0% vs 0.1%; p < 0.001).

Conclusions

Cancer survivors have higher mortality rates, no difference in CAD on CTA, higher CAC percentiles and more often malignancy on CTA compared with patients without a cancer history.

Electronic supplementary material

The online version of this article (10.1007/s12471-019-1268-8) contains supplementary material, which is available to authorized users.

The heart's exposure to radiation increases the risk of cardiac toxicity after chemoradiotherapy for superficial esophageal cancer: a retrospective cohort study

Background

Chemoradiotherapy effectively treats superficial esophageal cancer and is optimal to preserve organs. However, late toxicity, particularly in cardiac diseases, obstructs clinical outcomes. We revealed the risk factors for cardiac event development post-chemoradiotherapy.

Methods

Data from 80 patients who were diagnosed with submucosal invasive esophageal cancer without metastasis (confirmed using multiple modalities) and who underwent chemoradiotherapy between 2006 and 2014 were analyzed. Patients were 11% (9/80) female, and the median age and follow-up were 66.5 y and 73 mo, respectively. We calculated the individual radiation dose to the heart and analyzed relationships between the cardiac event occurrence rate and each clinical factor.

Results

The 5-y overall and recurrence-free survival rates were 74.6 and 62.4%, respectively. Among the total number of deaths, 34.6% was caused by esophageal cancer. During the follow-up, 13 patients developed severe cardiac events (ischemic heart diseases, n = 7; pericardial effusion, n = 3, atrial fibrillation, n = 1; and sudden death, n = 2). The significant risk factor for cardiac events post-chemoradiotherapy was the level of the heart’s exposure to radiation, with higher exposure associated with greater occurrence. History of smoking, obesity, comorbidity, and history of cardiac disease were unrelated to cardiac event occurrence post-chemoradiotherapy.

Conclusions

Chemoradiotherapy is a favorable intervention for superficial esophageal cancer. Reducing the radiation dose to the heart likely contributes to preventing cardiac toxicity post-chemoradiotherapy.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5421-y) contains supplementary material, which is available to authorized users.

Effects of Ramadan Fasting on Serum Amyloid A and Protein Carbonyl Group Levels in Patients With Cardiovascular Diseases

Introduction: Serum amyloid-A (SAA) and protein carbonyl group are rigorously related with cardiovascular diseases (CVDs) as a sensitive marker of an acute inflammatory state and as an important index of oxidative stress, respectively. Moreover, diet is one of the main factors that can modify cardiovascular risks. Therefore, this study aimed to investigate the effects of Ramadan fasting on SAA and protein carbonyl group levels in patients with CVDs.

Methods: Twenty-one patients (21 male; mean age 52±9 years old) with CVDs (coronary artery disease, cerebrovascular, or peripheral arterial diseases) were participated in this study. Biochemical parameters were measured in patients 2 days before and 2 days after Ramadan fasting. SAA levels were assessed using enzyme-linked immunosorbent assay and Cayman’s protein carbonyl colorimetric assay was provided for measuring protein carbonyl groups.

Results: According to the findings of the study, post-Ramadan levels of inflammatory biomarker, SAA was decreased significantly in patients with CVDs in comparison with the baseline before-fasting values (16.84±8.20 vs. 24.40±6.72 μg/ml, P = 0.021). In addition, Ramadan fasting significantly reduced the levels of protein carbonyl group in patients as compared with those of baseline values (33.08±15.31 vs. 43.65±16.88 nmol/ml, P = 0.039).

Conclusion: Ramadan fasting has impressive effects on modulating CVDs by decreasing inflammation and oxidative stress markers. However, to get a clear conclusion with more results, further investigation is warranted.