1
|
Pang L, Cai C, Aggarwal P, Wang D, Vijay V, Bagam P, Blamer J, Matter A, Turner A, Ren L, Papineau K, Srinivasasainagendra V, Tiwari HK, Yang X, Schnackenberg L, Mattes W, Broeckel U. Predicting oncology drug-induced cardiotoxicity with donor-specific iPSC-CMs-a proof-of-concept study with doxorubicin. Toxicol Sci 2024; 200:79-94. [PMID: 38547396 DOI: 10.1093/toxsci/kfae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Many oncology drugs have been found to induce cardiotoxicity in a subset of patients, which significantly limits their clinical use and impedes the benefit of lifesaving anticancer treatments. Human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) carry donor-specific genetic information and have been proposed for exploring the interindividual difference in oncology drug-induced cardiotoxicity. Herein, we evaluated the inter- and intraindividual variability of iPSC-CM-related assays and presented a proof of concept to prospectively predict doxorubicin (DOX)-induced cardiotoxicity (DIC) using donor-specific iPSC-CMs. Our findings demonstrated that donor-specific iPSC-CMs exhibited greater line-to-line variability than the intraindividual variability in impedance cytotoxicity and transcriptome assays. The variable and dose-dependent cytotoxic responses of iPSC-CMs resembled those observed in clinical practice and largely replicated the reported mechanisms. By categorizing iPSC-CMs into resistant and sensitive cell lines based on their time- and concentration-related phenotypic responses to DOX, we found that the sensitivity of donor-specific iPSC-CMs to DOX may predict in vivo DIC risk. Furthermore, we identified a differentially expressed gene, DND microRNA-mediated repression inhibitor 1 (DND1), between the DOX-resistant and DOX-sensitive iPSC-CMs. Our results support the utilization of donor-specific iPSC-CMs in assessing interindividual differences in DIC. Further studies will encompass a large panel of donor-specific iPSC-CMs to identify potential novel molecular and genetic biomarkers for predicting DOX and other oncology drug-induced cardiotoxicity.
Collapse
Affiliation(s)
- Li Pang
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Chengzhong Cai
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Praful Aggarwal
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| | - Dong Wang
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Vikrant Vijay
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Prathyusha Bagam
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Jacob Blamer
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| | - Andrea Matter
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| | - Amy Turner
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| | - Lijun Ren
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Katy Papineau
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Vinodh Srinivasasainagendra
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Xi Yang
- Division of Pharmacology & Toxicology, Office of Cardiology, Hematology, Endocrinology, & Nephrology, Office of New Drug, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Laura Schnackenberg
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - William Mattes
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas 72079, USA
| | - Ulrich Broeckel
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| |
Collapse
|
2
|
Kim SY, Kang HJ, Kim KH, Kim DU, Nam SJ, Yang JK, Jang DK, Choi HS, Ryu DG, Lee JW, Lee JY, Park S, Lee HJ. Cardiovascular disease risk and associated physical activity factors in gastrointestinal cancer survivors. BMC Public Health 2024; 24:1656. [PMID: 38902653 PMCID: PMC11191341 DOI: 10.1186/s12889-024-19097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Although the risk of CVD is increased in cancer survivors, few studies have investigated the CVD risk in survivors of gastrointestinal (GI) cancer. Therefore, we evaluated the CVD risk using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score for GI cancer survivors and associated physical activity factors. METHODS Using the 2014-2019 Korean National Health and Nutrition Examination Surveys, data were collected for 262 GI cancer survivors and 1,310 cancer-free controls matched at a 1:5 ratio based on age and sex. The International Physical Activity Questionnaire Short-Form was used to assess physical activity, and the Euro QoL Questionnaire 5-Dimensional Classification (EQ-5D) was used to assess the health-related quality of life. RESULTS A multiple logistic regression analysis demonstrated a lower risk of ASCVD in GI cancer survivors than in controls (adjusted odds ratio [aOR] = 0.73, 95% confidence interval [CI] = 0.55-0.97). Moreover, the risk of having a high ASCVD score was significantly lower in individuals who performed sufficient aerobic physical activity (aOR = 0.59, 95% CI = 0.47-0.75) and those with an EQ-5D score 1 or 2 (aOR = 0.36, 95% CI = 0.20-0.65 and aOR = 0.31, 95% CI = 0.16-0.58, respectively). CONCLUSIONS This population-based study demonstrated that engaging in sufficient physical activity can reduce the ASCVD risk among GI cancer survivors.
Collapse
Affiliation(s)
- Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye Jung Kang
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-Ro, Sodeamun-Gu, Seoul, 03722, Republic of Korea
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Republic of Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jae Kook Yang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jung Wook Lee
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jong Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Sohee Park
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-Ro, Sodeamun-Gu, Seoul, 03722, Republic of Korea.
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
3
|
Birch S, Otton J. Cardio-oncology and radiation oncology: How collaboration between cardiologists and oncologists can be realised in radiation oncology. J Med Imaging Radiat Oncol 2024. [PMID: 38874328 DOI: 10.1111/1754-9485.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
Increased survivorship, improvements in cancer treatments, and the potential for cardiac side effects from cancer treatments have resulted in increased collaboration between oncologists and cardiologists and the development of cardio-oncology clinics. This collaboration is important given its role in ensuring greater patient satisfaction, aiding teams of clinicians in making complex treatment decision, and ensuring cardiac complications are diagnosed at an early stage. The particularities of implementing this collaboration in the field of radiation oncology and how this setting is different from other areas of cardio-oncology have not been well detailed in the literature. This paper will discuss what is currently understood about the need for and role of cardio-oncology and what a cardio-oncology services involves, with a particular emphasis on patient and clinician needs in the field of radiation oncology. The literature and recent guidelines do advocate for a detailed baseline assessment of cancer patients undergoing radiotherapy, especially patients with treatment or patient risk factors that increase their risk of cancer-therapy related cardiotoxicity. Advancements in cardiac imaging techniques will be discussed as these may help to diagnose cardiac side effects of certain cancer treatments, including radiotherapy, at an early stage. A multi-disciplinary and collaborative approach is well received by patients and such an approach, guided by the aim of maintaining a patient's cancer treatment wherever possible, should be the cornerstone of cardio-oncology clinics regardless of the patient's treatment regime.
Collapse
Affiliation(s)
- Samuel Birch
- Cardiology Department, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - James Otton
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Hong D, Yin M, Li J, Deng Z, Ren Z, Zhou Y, Huang S, Yan X, Zhong W, Liu F, Yang C. Cardiovascular mortality among patients with diffuse large B-cell lymphoma: a population-based study. Leuk Lymphoma 2024:1-11. [PMID: 38861618 DOI: 10.1080/10428194.2024.2364830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
We aim to investigate cardiovascular mortality risk among diffuse large B-cell lymphoma (DLBCL) patients and explore cardiovascular mortality trends in the past decades in United States. We extracted data from the Surveillance, Epidemiology, and End Results database for adult patients diagnosed with DLBCL between 1975 and 2019. Standardized mortality ratio, joinpoint regression analysis, and competing risk model were analyzed. Overall, 49,918 patients were enrolled, of whom 4167 (8.3%) cardiovascular deaths were observed, which was 1.22 times the number expected (95%CI, 1.19-1.26). During 1985-2019, the incidence-based cardiovascular mortality rate increased by 0.98% per year (95%CI, 0.58-1.39%), with statistically significant increases in age groups younger than 75 years. The cumulative mortality from cardiovascular disease increased by age but never exceeded that from DLBCL. Older age, male sex, earlier year of diagnosis, lower tumor stage at diagnosis, chemotherapy, radiotherapy, and surgery were all poor prognostic factors for cardiovascular mortality.
Collapse
Affiliation(s)
- Danhua Hong
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Mengzhuo Yin
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jie Li
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhiyong Deng
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhilei Ren
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yun Zhou
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shuijin Huang
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xuejun Yan
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
- School of Medicine, Institute of Clinical Medicine, Center for Medical Research on Innovation and Translation, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Weijie Zhong
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng Liu
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Chongzhe Yang
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| |
Collapse
|
5
|
Dutra JPP, Macedo AVS, Peixoto TFLF, Garcez JDS, Bacchiega BC, Marchi PD, Varela AM, Martins BJA, Silva CMPDDCE, Lopes RD. Cardiology and oncology: a meeting of giants. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S114. [PMID: 38865534 PMCID: PMC11164274 DOI: 10.1590/1806-9282.2024s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 06/14/2024]
Affiliation(s)
| | | | | | | | | | | | - Alexandre Manoel Varela
- Universitário Mackenzie, Curitiba Hospital, Erasto Gaertner Hospital – Curitiba (PR), Brazil
| | - Bianca Jaccoud Amaral Martins
- Centro de Pesquisa Oncológica, SOS Cardio Hospital, Florianópolis Specialized Oncology Center – Florianópolis (SC), Brazil
| | | | - Renato Delascio Lopes
- Duke University, Duke Clinical Research Institute, School of Medicine – Durham (NC), United States
| |
Collapse
|
6
|
Cao C, Yang L, Nohria A, Mayer EL, Partridge AH, Ligibel JA. Association of N-terminal pro-brain natriuretic peptide with survival among US cancer survivors. J Natl Cancer Inst 2024; 116:938-947. [PMID: 38299668 PMCID: PMC11160495 DOI: 10.1093/jnci/djae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cardiac biomarker associated with the risk of heart failure and death in the general population, but it has not been explored in cancer survivors. METHODS Using a US nationally representative sample of adults 20 years of age and older from the National Health and Nutrition Examination Survey from 1999 to 2004, this study compared NT-proBNP levels between adults without cancer (n = 12 574) and adult cancer survivors (n = 787). It examined the association of NT-proBNP with all-cause and cause-specific mortality among cancer survivors. RESULTS Cancer survivors had higher NT-proBNP levels than adults without cancer (median [interquartile range] = 125.4 pg/mL [52.4-286.0] vs 43.2 pg/mL [20.3-95.0]). In particular, survivors of breast, prostate, and colorectal cancers had higher NT-proBNP levels than adults without cancer (multivariable-adjusted P < .05). In total, 471 survivors died (141 from cancer; 95 from cardiac disease) during a median follow-up period of 13.4 years (9393 person-years). Among cancer survivors, higher NT-proBNP levels were statistically associated with increased risks of all-cause death (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.18 to 1.46) and cardiac death (HR = 1.55, 95% CI = 1.21 to 2.00) but not with death from cancer (HR = 1.10, 95% CI = 0.92 to 1.32]). Higher NT-proBNP levels were associated with elevated overall mortality in survivors of prostate cancer (HR = 1.49, 95% CI = 1.22 to 1.81) and colorectal cancer (HR = 1.78, 95% CI = 1.00 to 3.16) (P = .169 for interaction). Nonlinear dose-response relationships were observed between NT-proBNP and mortality, with statistically significant relationships emerging above 125 pg/mL. CONCLUSIONS Cancer survivors had higher NT-proBNP levels than adults without cancer, and elevated NT-proBNP levels were associated with higher risks of all-cause and cardiac mortality in cancer survivors.
Collapse
Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
7
|
Fabiani I, Chianca M, Aimo A, Emdin M, Dent S, Fedele A, Cipolla CM, Cardinale DM. Use of new and emerging cancer drugs: what the cardiologist needs to know. Eur Heart J 2024; 45:1971-1987. [PMID: 38591670 DOI: 10.1093/eurheartj/ehae161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
The last decade has witnessed a paradigm shift in cancer therapy, from non-specific cytotoxic chemotherapies to agents targeting specific molecular mechanisms. Nonetheless, cardiovascular toxicity of cancer therapies remains an important concern. This is particularly relevant given the significant improvement in survival of solid and haematological cancers achieved in the last decades. Cardio-oncology is a subspecialty of medicine focusing on the identification and prevention of cancer therapy-related cardiovascular toxicity (CTR-CVT). This review will examine the new definition of CTR-CVT and guiding principles for baseline cardiovascular assessment and risk stratification before cancer therapy, providing take-home messages for non-specialized cardiologists.
Collapse
Affiliation(s)
- Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Michela Chianca
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Antonella Fedele
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Carlo Maria Cipolla
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Daniela Maria Cardinale
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| |
Collapse
|
8
|
Cannavale KL, Xu L, Nau CL, Armenian SH, Bhatia S, Wong FL, Huang PYS, Cooper R, Chao CR. Neighborhood factors associated with late effects among survivors of adolescent and young adult cancer. J Cancer Surviv 2024:10.1007/s11764-024-01596-1. [PMID: 38839694 DOI: 10.1007/s11764-024-01596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the associations between neighborhood income, education, and neighborhood racial composition (measured as a low percentage of white residents) and risk of developing cardiovascular diseases (CVD), diabetes (DM), and severe depression among survivors of AYA cancer and matched non-cancer peers. METHODS Two-year survivors of AYA cancers diagnosed at age 15-39 yrs at Kaiser Permanente Southern California (diagnosed 2000-2012) and individually matched (1:13) non-cancer subjects were included. The development of CVD, DM, and severe depression was ascertained via electronic health records. Neighborhood characteristics were obtained from census-based geocoded data. Cox regression evaluated associations between neighborhood characteristics and the health outcomes of interest among both the cancer survivors and the non-cancer comparison cohort and effect modification by cancer survivor status on these relationships. RESULTS Among cancer survivors (n = 6774), living in mostly non-white neighborhoods, was associated with risk of CVD (hazard ratio (HR) = 1.54 (95% CI 1.00-2.36)), while lower education level (HR = 1.41 (95% CI 1.02-1.94)) was associated with risk of severe depression. None of the neighborhood characteristics were associated with risk of DM. Effect modification was found for neighborhood education and risk of DM and severe depression. CONCLUSION When jointly considered, cancer survivors who resided in the most disadvantaged neighborhoods were at the highest risk of developing these health outcomes compared to other subgroups. IMPLICATIONS FOR CANCER SURVIVORS Our findings may inform screening strategy and addressing social determinants of health among AYA cancer survivors.
Collapse
Affiliation(s)
- Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lanfang Xu
- MedHealth Analytics Inc., Sugar Land, TX, USA
| | - Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, CA, USA
- Department of Pediatrics, City of Hope, Duarte, CA, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Po-Yin Samuel Huang
- Department of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Robert Cooper
- Department of Pediatric Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
| |
Collapse
|
9
|
Oh HS, Kim TH, Kim JW, Yang J, Lee HS, Lee JH, Park CH. Feasibility and limitations of deep learning-based coronary calcium scoring in PET-CT: a comparison with coronary calcium score CT. Eur Radiol 2024; 34:4077-4088. [PMID: 37962596 DOI: 10.1007/s00330-023-10390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE This study aimed to determine the feasibility and limitations of deep learning-based coronary calcium scoring using positron emission tomography-computed tomography (PET-CT) in comparison with coronary calcium scoring using ECG-gated non-contrast-enhanced cardiac computed tomography (CaCT). MATERIALS AND METHODS A total of 215 individuals who underwent both CaCT and PET-CT were enrolled in this retrospective study. The Agatston method was used to calculate the coronary artery calcium scores (CACS) from CaCT, PET-CT(reader), and PET-CT(AI) to analyse the effect of using different modalities and AI-based software on CACS measurement. The total CACS and CACS classified according to the CAC-DRS guidelines were compared between the three sets of CACS. The differences, correlation coefficients, intraclass coefficients (ICC), and concordance rates were analysed. Statistical significance was set at p < 0.05. RESULTS The correlation coefficient of the total CACS from CaCT and PET-CT(reader) was 0.837, PET-CT(reader) and PET-CT(AI) was 0.894, and CaCT and PET-CT(AI) was 0.768. The ICC of CACS from CaCT and PET-CT(reader) was 0.911, PET-CT(reader) and PET-CT(AI) was 0.958, and CaCT and PET-CT(AI) was 0.842. The concordance rate between CaCT and PET-CT(AI) was 73.8%, with a false-negative rate of 37.3% and a false-positive rate of 4.4%. Age and male sex were associated with an increased misclassification rate. CONCLUSIONS Artificial intelligence-assisted CACS measurements in PET-CT showed comparable results to CACS in coronary calcium CT. However, the relatively high false-negative results and tendency to underestimate should be of concern. CLINICAL RELEVANCE STATEMENT Application of automated calcium scoring to PET-CT studies could potentially select patients at high risk of coronary artery disease from among cancer patients known to be susceptible to coronary artery disease and undergoing routine PET-CT scans. KEY POINTS • Cancer patients are susceptible to coronary disease, and PET-CT could be potentially used to calculate coronary artery calcium score (CACS). • Calcium scoring using artificial intelligence in PET-CT automatically provides CACS with high ICC to CACS in coronary calcium CT. • However, underestimation and false negatives of CACS calculation in PET-CT should be considered.
Collapse
Affiliation(s)
- Hee Sang Oh
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Ji Won Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
| | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
| |
Collapse
|
10
|
Heuchan GN, Lally PJ, Beeken RJ, Fisher A, Conway RE. Perception of a need to change weight in individuals living with and beyond breast, prostate and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2024; 18:844-853. [PMID: 36701100 PMCID: PMC11081928 DOI: 10.1007/s11764-023-01333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE People living with and beyond cancer (LWBC) are advised to achieve a body mass index (BMI) within the healthy range (≥ 18.5 and < 25). Not perceiving a need for weight change may be a barrier to achieving a healthy weight. This study aimed to explore factors associated with perceived need for weight change among people LWBC. METHODS Adults diagnosed with breast, prostate, or colorectal cancer were recruited through National Health Service sites in Essex and London. Participants (N = 5835) completed the 'Health and Lifestyle After Cancer' survey, which included a question on perceived need to change weight. Associations between perceived need for weight change and BMI, and perceived need for weight change and health and demographic variables, were analyzed using chi-square tests and logistic regression, respectively. RESULTS The proportion of participants perceiving a need to lose weight differed according to BMI category: healthy weight (23%), overweight (64%), obese (85%) (P < 0.001). Having overweight or obesity but not perceiving a need to lose weight was associated with being older, male, non-white, not married or cohabiting, and having cancer that had spread, no formal qualifications, no comorbidities, and having received chemotherapy. CONCLUSIONS Perceived need to lose weight is prevalent among people LWBC with obesity and overweight. This group may be interested in weight management support. Demographic and health factors were associated with having obesity or overweight but not perceiving a need to lose weight. IMPLICATIONS FOR CANCER SURVIVORS Weight loss interventions for people LWBC are needed. A subset of people LWBC with overweight and obesity may need additional information or motivators to engage with weight management.
Collapse
Affiliation(s)
- Gabriella N Heuchan
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa J Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychology, University of Surrey, Guildford, Surrey, GU2 7HX, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rana E Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| |
Collapse
|
11
|
Ueno K, Kaneko H, Suzuki Y, Okada A, Fujiu K, Jo T, Takeda N, Kamiya K, Ako J, Morita H, Node K, Yasunaga H, Komuro I. Change in Body Mass Index and Cardiovascular Outcomes in Patients With Cancer. Mayo Clin Proc 2024; 99:891-901. [PMID: 38703179 DOI: 10.1016/j.mayocp.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) changes and the risk of cardiovascular disease (CVD) in patients with cancer. PATIENTS AND METHODS This retrospective observational study used data from the JMDC Claims Database obtained between January 2005, and April 2021. We included 52,344 individuals (median [IQR] age, 53 years [46 to 60 years]; 23,584 [45.1%] men) with cancer and no prior CVD. Patients were classified into 3 groups based on the percentage change in BMI from the initial health checkup to the checkup 1 year later: -5.0% or less (BMI loss), -5.0% to 5.0% (stable BMI), and 5.0% or more (BMI gain). The primary end point was composite CVD events including heart failure, atrial fibrillation, ischemic heart disease, and stroke. RESULTS During a median follow-up period of 763 days (IQR, 369 to 1274 days), 3124 composite CVD events were observed. Compared with stable BMI, the hazard ratios (HRs) of BMI loss and gain for CVD events were 1.16 (95% CI, 1.00 to 1.34) and 1.10 (95% CI, 0.96 to 1.25), respectively. A U-shaped association was observed between the BMI changes and CVD events, particularly for nonatherosclerotic CVD outcomes including heart failure and atrial fibrillation. Compared with stable BMI, both BMI loss and gain increased the risk of heart failure (HR, 1.30; 95% CI, 1.08 to 1.57 and HR, 1.22; 95% CI, 1.02 to 1.47, respectively) and atrial fibrillation (HR, 1.70; 95% CI, 1.18 to 2.45 and HR, 1.55; 95% CI, 1.07 to 2.24, respectively). CONCLUSION Cancer survivors with BMI loss and gain were at greater risk of CVD. Body mass index loss is associated with a higher risk of CVD.
Collapse
Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan.
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
12
|
Ueno K, Kaneko H, Suzuki Y, Okada A, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Ako J, Node K, Yasunaga H, Komuro I. Metabolic syndrome and cardiovascular disease in cancer survivors. J Cachexia Sarcopenia Muscle 2024; 15:1062-1071. [PMID: 38515400 PMCID: PMC11154793 DOI: 10.1002/jcsm.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/01/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The risk of subsequent cardiovascular disease (CVD) is high in cancer survivors. Although metabolic syndrome is an established risk factor for CVD, its association with cancer survivors has not yet been established. This study aimed to clarify whether metabolic syndrome is associated with subsequent CVD risk in patients with cancer using a nationwide epidemiological dataset. METHODS We retrospectively analysed 53 510 patients with a history of breast, colorectal, or stomach cancer, which is reportedly a major site for developing cancer in Japan. Study participants were categorized into two groups based on the presence of metabolic syndrome, defined using the Japanese criteria (high waist circumference and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). The clinical outcomes were collected between 2005 and 2021. The primary endpoint was defined as the composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure. RESULTS The median patient age was 54 years, and 37.5% of the patients were men. Metabolic syndrome was observed in 5558 (10.4%) patients. Over a mean follow-up period of 973 ± 791 days, 3085 composite CVD outcomes were recorded. Multivariable Cox regression analyses showed that metabolic syndrome was associated with a greater risk of developing CVD events (HR = 1.29, 95% CI = 1.15-1.45). Metabolic syndrome was also associated with an increased risk of CVD in patients with a follow-up period ≥1 year (HR = 1.33, 95% CI = 1.15-1.53). This relationship was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.34, 95% CI = 1.21-1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.32, 95% CI = 1.19-1.46). Subgroup analyses showed that the relationship between metabolic syndrome and incident CVD was more pronounced in the non-obese participants than in the obese participants. CONCLUSIONS Metabolic syndrome is associated with a greater risk of developing CVD, even among cancer survivors.
Collapse
Grants
- 21AA2007 Ministry of Health, Labour and Welfare, Japan
- 21K08123 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 21H03159 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science and Technology, Japan
- Ministry of Health, Labour and Welfare, Japan
Collapse
Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Rehabilitation Sciences, Graduate School of Medical SciencesKitasato UniversityKanagawaJapan
| | - Hidehiro Kaneko
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Advanced CardiologyUniversity of TokyoTokyoJapan
| | - Yuta Suzuki
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Satoshi Matsuoka
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Advanced CardiologyUniversity of TokyoTokyoJapan
| | | | - Taisuke Jo
- Department of Health Services ResearchUniversity of TokyoTokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health SciencesKitasato UniversityKanagawaJapan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of MedicineKitasato UniversityKanagawaJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthUniversity of TokyoTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| |
Collapse
|
13
|
Ogilvie LM, Coyle-Asbil B, Brunt KR, Petrik J, Simpson JA. Therapy-naïve malignancy causes cardiovascular disease: a state-of-the-art cardio-oncology perspective. Am J Physiol Heart Circ Physiol 2024; 326:H1515-H1537. [PMID: 38639740 DOI: 10.1152/ajpheart.00795.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Cardiovascular disease (CVD) and cancer are the leading causes of mortality worldwide. Although generally thought of as distinct diseases, the intersectional overlap between CVD and cancer is increasingly evident in both causal and mechanistic relationships. The field of cardio-oncology is largely focused on the cardiotoxic effects of cancer therapies (e.g., chemotherapy, radiation). Furthermore, the cumulative effects of cardiotoxic therapy exposure and the prevalence of CVD risk factors in patients with cancer lead to long-term morbidity and poor quality of life in this patient population, even when patients are cancer-free. Evidence from patients with cancer and animal models demonstrates that the presence of malignancy itself, independent of cardiotoxic therapy exposure or CVD risk factors, negatively impacts cardiac structure and function. As such, the primary focus of this review is the cardiac pathophysiological and molecular features of therapy-naïve cancer. We also summarize the strengths and limitations of preclinical cancer models for cardio-oncology research and discuss therapeutic strategies that have been tested experimentally for the treatment of cancer-induced cardiac atrophy and dysfunction. Finally, we explore an adjacent area of interest, called "reverse cardio-oncology," where the sequelae of heart failure augment cancer progression. Here, we emphasize the cross-disease communication between malignancy and the injured heart and discuss the importance of chronic low-grade inflammation and endocrine factors in the progression of both diseases.
Collapse
Affiliation(s)
- Leslie M Ogilvie
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Bridget Coyle-Asbil
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Keith R Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Jim Petrik
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| |
Collapse
|
14
|
SenthilKumar G, Verhagen NB, Nimmer K, Yang X, Figueroa Castro CE, Szabo A, Taylor BW, Wainaina N, Gould JC, Kothari AN. Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery. J Am Coll Surg 2024; 238:1085-1097. [PMID: 38348959 DOI: 10.1097/xcs.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of patients with cancer and a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACEs) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk. STUDY DESIGN National COVID Cohort Collaborative Data Enclave, a large multi-institutional dataset, was used to identify patients that underwent surgical cancer resection between January 2020 and February 2023. Multivariate regression analysis adjusting for demographics, comorbidities, and risk of surgery was performed to evaluate risk for 30-day postoperative MACE. RESULTS Of 204,371 included patients, 21,313 (10.4%) patients had a history of preoperative COVID-19. History of COVID-19 was associated with an increased risk for postoperative composite MACE as well as 30-day mortality. Among patients with mild disease who did not require hospitalization, MACE risk was elevated for up to 4 weeks after infection. Postoperative MACE risk remained elevated more than 8 weeks after infection in those with moderate disease. Vaccination did not reduce risk for postoperative MACE. CONCLUSIONS Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients' cardiovascular fitness and prevent COVID-19 infection are needed.
Collapse
Affiliation(s)
- Gopika SenthilKumar
- From the Medical Scientist Training Program (SenthilKumar), Medical College of Wisconsin, Milwaukee, WI
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Nathaniel B Verhagen
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Kaitlyn Nimmer
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Xin Yang
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Carlos E Figueroa Castro
- Division of Infectious Diseases, Department of Medicine (Figueroa Castro, Wainaina), Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Department of Biostatistics (Szabo), Medical College of Wisconsin, Milwaukee, WI
| | - Bradley W Taylor
- Clinical and Translational Science Institute of Southeastern Wisconsin (Taylor, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Njeri Wainaina
- Division of Infectious Diseases, Department of Medicine (Figueroa Castro, Wainaina), Medical College of Wisconsin, Milwaukee, WI
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery (Gould), Medical College of Wisconsin, Milwaukee, WI
| | - Anai N Kothari
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
- Clinical and Translational Science Institute of Southeastern Wisconsin (Taylor, Kothari), Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
15
|
Kunhiraman HH, Guha A. Prostate cancer and cardiovascular disease: Racial/ethnic disparities and role of chronic toxic stress/allostatic load. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 42:100397. [PMID: 38680647 PMCID: PMC11053262 DOI: 10.1016/j.ahjo.2024.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Affiliation(s)
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, GA, USA
| |
Collapse
|
16
|
Singh A, Gallaway MS, Rascon A. A comparison of chronic conditions and health characteristics between cancer survivors and non-cancer survivors. Chronic Illn 2024; 20:349-359. [PMID: 37724026 PMCID: PMC11046444 DOI: 10.1177/17423953231180191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe demographics, risk factors, and comorbid health conditions in adult cancer survivors. METHOD We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed. RESULTS Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors. DISCUSSION These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life.
Collapse
Affiliation(s)
- Anjin Singh
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
- CDC Foundation, 600 Peachtree St NE #100, Atlanta, GA, 30308
| | - Michael Shayne Gallaway
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333
| | - Addey Rascon
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
| |
Collapse
|
17
|
Logotheti S, Pavlopoulou A, Rudsari HK, Galow AM, Kafali Y, Kyrodimos E, Giotakis AI, Marquardt S, Velalopoulou A, Verginadis II, Koumenis C, Stiewe T, Zoidakis J, Balasingham I, David R, Georgakilas AG. Intercellular pathways of cancer treatment-related cardiotoxicity and their therapeutic implications: The paradigm of radiotherapy. Pharmacol Ther 2024:108670. [PMID: 38823489 DOI: 10.1016/j.pharmthera.2024.108670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/16/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Advances in cancer therapeutics have improved patient survival rates. However, cancer survivors may suffer from adverse events either at the time of therapy or later in life. Cardiovascular diseases (CVD) represent a clinically important, but mechanistically understudied complication, which interfere with the continuation of best-possible care, induce life-threatening risks, and/or lead to long-term morbidity. These concerns are exacerbated by the fact that targeted therapies and immunotherapies are frequently combined with radiotherapy, which induces durable inflammatory and immunogenic responses, thereby providing a fertile ground for the development of cardiovascular diseases (CVDs). Stressed and dying irradiated cells produce 'danger' signals including, but not limited to, major histocompatibility complexes, cell-adhesion molecules, proinflammatory cytokines, and damage-associated molecular patterns. These factors activate intercellular signaling pathways which have potentially detrimental effects on the heart tissue homeostasis. Herein, we present the clinical crosstalk between cancer and heart diseases, describe how it is potentiated by cancer therapies, and highlight the multifactorial nature of the underlying mechanisms. We particularly focus on radiotherapy, as a case known to often induce cardiovascular complications even decades after treatment. We provide evidence that the secretome of irradiated tumors entails factors that exert systemic, remote effects on the cardiac tissue, potentially predisposing it to CVDs. We suggest how diverse disciplines can utilize pertinent state-of-the-art methods in feasible experimental workflows, to shed light on the molecular mechanisms of radiotherapy-related cardiotoxicity at the organismal level and untangle the desirable immunogenic properties of cancer therapies from their detrimental effects on heart tissue. Results of such highly collaborative efforts hold promise to be translated to next-generation regimens that maximize tumor control, minimize cardiovascular complications, and support quality of life in cancer survivors.
Collapse
Affiliation(s)
- Stella Logotheti
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
| | - Athanasia Pavlopoulou
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | | | - Anne-Marie Galow
- Institute for Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - Yağmur Kafali
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephan Marquardt
- Institute of Translational Medicine for Health Care Systems, Medical School Berlin, Hochschule Für Gesundheit Und Medizin, 14197 Berlin, Germany
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorsten Stiewe
- Institute of Molecular Oncology, Philipps-University, 35043 Marburg, Germany; German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), 35043 Marburg, Germany; Genomics Core Facility, Philipps-University, 35043 Marburg, Germany; Institute for Lung Health (ILH), Justus Liebig University, 35392 Giessen, Germany
| | - Jerome Zoidakis
- Department of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece; Department of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany; Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
| |
Collapse
|
18
|
Sannala CKR, MacLean C, Larsen F, van Os S, Jadhav P, Shore N, Morgans AK, Okwuosa T, Gobburu J. A Model-Informed Drug Development Approach to Design a Phase 3 Trial of Teverelix Drug Product in Advanced Prostate Cancer Patients with Increased Cardiovascular Risk. Clin Pharmacol Drug Dev 2024. [PMID: 38757461 DOI: 10.1002/cpdd.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Teverelix drug product (DP) is a parenteral gonadotropin-releasing hormone (GnRH) antagonist that has been successfully tested in phase 2 trials for hormone-sensitive advanced prostate cancer (APC) and benign prostatic hyperplasia (BPH). In previous APC trials, teverelix DP was administered as intramuscular (IM) and subcutaneous (SC) injections, using a loading dose and (in a single trial) a maintenance dose. Our objective was to derive an optimal dosing regimen for phase 3 clinical development, using a pharmacometrics modeling approach. Data from 9 phase 2 studies (229 patients) was utilized to develop a population pharmacokinetic (PK) model that described the concentration profile accommodating both IM and SC routes of administration. A 2-compartment model with sequential first-order absorption (slow and fast) and lag times best described the PK profiles of teverelix following SC and IM administration. An indirect response model with inhibition of production rate was fit to describe testosterone (T) concentrations based on physiological relevance. The final population PK-pharmacodynamic model was used to conduct simulations of various candidate dosing regimens to select the optimal dosing regimen to achieve clinical castration (T < 0.5 ng/mL by day 28) and to sustain clinical castration for 26 weeks. Model simulation showed that a loading dose of 360 mg SC and 180 mg IM with a maintenance dose of 360 mg SC 6-weekly (Q6W) starting at day 28 can achieve a ≥95% castration rate up to 52 weeks. This dose regimen was selected for phase 3 clinical development, which includes cardiovascular safety assessment in comparison to a GnRH agonist.
Collapse
Affiliation(s)
| | | | | | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | | | | | | |
Collapse
|
19
|
Uttam Chandani K, Agrawal SP, Raval M, Siddiq S, Nadeem A, Chintakuntlawar AV, Hashmi SK. Racial Disparities in Cardiovascular and Cerebrovascular Adverse Events in Patients with Non-Hodgkin Lymphoma: A Nationwide Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:800. [PMID: 38792983 PMCID: PMC11123259 DOI: 10.3390/medicina60050800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. Materials and Methods: Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016-2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient's race. Results: Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17-1.38, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12-1.45, p < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52-2.16, p < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60-0.81, p < 0.001), Hispanic patients (0.69, 95% CI 0.59-0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43-0.75, p < 0.001) as compared to White patients. Conclusions: Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative.
Collapse
Affiliation(s)
- Kanishka Uttam Chandani
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA;
| | | | - Maharshi Raval
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA;
| | - Sajid Siddiq
- Department of Cardiology, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA
| | - Ahmed Nadeem
- Department of Hematology-Oncology, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA
| | | | - Shahrukh K. Hashmi
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Computer Vision, MBZ University of Artificial Intelligence, Abu Dhabi, United Arab Emirates
| |
Collapse
|
20
|
Chang ET, Clarke CA, Colditz GA, Kurian AW, Hubbell E. Avoiding lead-time bias by estimating stage-specific proportions of cancer and non-cancer deaths. Cancer Causes Control 2024; 35:849-864. [PMID: 38238615 PMCID: PMC11045653 DOI: 10.1007/s10552-023-01842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 04/26/2024]
Abstract
PURPOSE Understanding how stage at cancer diagnosis influences cause of death, an endpoint that is not susceptible to lead-time bias, can inform population-level outcomes of cancer screening. METHODS Using data from 17 US Surveillance, Epidemiology, and End Results registries for 1,154,515 persons aged 50-84 years at cancer diagnosis in 2006-2010, we evaluated proportional causes of death by cancer type and uniformly classified stage, following or extrapolating all patients until death through 2020. RESULTS Most cancer patients diagnosed at stages I-II did not go on to die from their index cancer, whereas most patients diagnosed at stage IV did. For patients diagnosed with any cancer at stages I-II, an estimated 26% of deaths were due to the index cancer, 63% due to non-cancer causes, and 12% due to a subsequent primary (non-index) cancer. In contrast, for patients diagnosed with any stage IV cancer, 85% of deaths were attributed to the index cancer, with 13% non-cancer and 2% non-index-cancer deaths. Index cancer mortality from stages I-II cancer was proportionally lowest for thyroid, melanoma, uterus, prostate, and breast, and highest for pancreas, liver, esophagus, lung, and stomach. CONCLUSION Across all cancer types, the percentage of patients who went on to die from their cancer was over three times greater when the cancer was diagnosed at stage IV than stages I-II. As mortality patterns are not influenced by lead-time bias, these data suggest that earlier detection is likely to improve outcomes across cancer types, including those currently unscreened.
Collapse
Affiliation(s)
- Ellen T Chang
- GRAIL, LLC, 1525 O'Brien Ave, Menlo Park, CA, 94025, USA.
| | | | - Graham A Colditz
- Institute for Public Health and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison W Kurian
- Division of Oncology, Department of Medicine, and Department of Epidemiology & Population Health, Stanford School of Medicine, Stanford, CA, USA
| | - Earl Hubbell
- GRAIL, LLC, 1525 O'Brien Ave, Menlo Park, CA, 94025, USA
| |
Collapse
|
21
|
Silva BV, Magalhães A, Menezes MN, Alves D, Mesquita I, Pinto FJ, Fiúza M. Chest Computed Tomography for Lymphoma Staging: A Wasted Opportunity for Cardiovascular Risk Stratification? Heart Lung Circ 2024; 33:657-663. [PMID: 38169236 DOI: 10.1016/j.hlc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
AIM Patients with a lymphoma diagnosis undergo non-gated chest computed tomography (CT) scans as part of cancer diagnosis or staging. Although coronary artery calcification (CAC) is traditionally evaluated on dedicated cardiac CT, CAC can also be detected on standard chest CT. This exploratory study aimed to determine the prognostic value of CAC detected on non-gated chest CT and to report its use on clinical practice. METHOD Consecutive patients with a lymphoma diagnosis who performed non-contrasted non-gated chest CT for cancer diagnosis or staging were included and retrospectively evaluated. Coronary artery calcification was evaluated by quantitative (Agatston score) and qualitative (visual) assessment. RESULTS Fifty-seven patients were included in this study (mean age 61±15 years; 58% male). Coronary artery calcification was identified in 22 patients (39%), most of them with multi-vessel involvement. Coronary artery calcification was qualitatively classified as mild, moderate and severe in 11%, 19% and 9% patients, respectively. This study suggested that moderate or severe CAC was an independent predictor of all-cause mortality (odds ratio 3, 95% confidence interval 2-11; p=0.04) after adjusting for cardiovascular risk factors and lymphoma staging. Regarding quantitative evaluation, a higher CAC score was also associated with higher mortality. While significant CAC was identified in 22 patients, it was only reported in four patients. CONCLUSIONS The preliminary findings of this hypothesis-generating study support the investigation of CAC identified by chest CT for diagnosis/staging of cancer as a risk modifier in the global risk assessment of patients with lymphoma. The unrecognition and underreporting of this finding may represent a wasted opportunity to detect subclinical coronary atherosclerosis in these patients and may help in guiding preventive cardiology care.
Collapse
Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Andreia Magalhães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela Alves
- Hematology Deparment, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Isabel Mesquita
- Hematology Deparment, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuela Fiúza
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
22
|
Kim K, Di Giovanna E, Jung H, Bethineedi LD, Jun TJ, Kim YH. Association of metabolic health and obesity with coronary heart disease in adult cancer survivors. Eur J Clin Invest 2024; 54:e14161. [PMID: 38239087 DOI: 10.1111/eci.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The metabolically healthy obese (MHO) phenotype is associated with an increased risk of coronary heart disease (CHD) in the general population. However, association of metabolic health and obesity phenotypes with CHD risk in adult cancer survivors remains unclear. We aimed to investigate the associations between different metabolic health and obesity phenotypes with incident CHD in adult cancer survivors. METHODS We used National Health Insurance Service (NHIS) to identify a cohort of 173,951 adult cancer survivors aged more than 20 years free of cardiovascular complications. Metabolically healthy nonobese (MHN), MHO, metabolically unhealthy nonobese (MUN), metabolically unhealthy obese (MUO) phenotypes were created using as at least three out of five metabolic health criteria along with obesity (body mass index ≥ 25.0 kg/m2). We used Cox proportional hazards model to assess CHD risk in each metabolic health and obesity phenotypes. RESULTS During 1,376,050 person-years of follow-up, adult cancer survivors with MHO phenotype had a significantly higher risk of CHD (hazard ratio [HR] = 1.52; 95% confidence intervals [CI]: 1.41 to 1.65) as compared to those without obesity and metabolic abnormalities. MUN (HR = 1.81; 95% CI: 1.59 to 2.06) and MUO (HR = 1.92; 95% CI: 1.72 to 2.15) phenotypes were also associated with an increased risk of CHD among adult cancer survivors. CONCLUSIONS Adult cancer survivors with MHO phenotype had a higher risk of CHD than those who are MHN. Metabolic health status and obesity were jointly associated with CHD risk in adult cancer survivors.
Collapse
Affiliation(s)
- Kyuwoong Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Edvige Di Giovanna
- Department of Diagnostic and Interventional Radiology, Ammerland-Klinik, Westerstede, Lower Saxony, Germany
| | - Hyeyun Jung
- Department of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Tae Joon Jun
- Big Data Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Hak Kim
- Big Data Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
23
|
Ulys A, Jankevicus F, Jievaltas M, Venckus R, Auskalnis S, Kardelis Z, Barisiene M, MacLean CM, van Os S, Larsen F. Efficacy, tolerability, and safety of teverelix DP in patients with advanced prostate cancer: A multicenter, open-label, phase 2 trial. Prostate 2024; 84:584-598. [PMID: 38311868 DOI: 10.1002/pros.24674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Teverelix drug product (DP) is a novel injectable gonadotropin-releasing hormone antagonist. METHODS An adaptive phase 2, open-label, multicenter trial was conducted in patients with advanced prostate cancer to evaluate the efficacy and safety of a combined subcutaneous (SC) and intramuscular (IM) loading dose regimen of teverelix DP of 120 mg SC + 120 mg IM (Group 1; N = 9) or 180 mg SC + 180 mg IM (Group 2; N = 41) administered at a single visit, followed by 6-weekly SC maintenance doses of 120 mg (Group 1) or 180 mg (Group 2), up to Day 168. The primary endpoint was the proportion of patients achieving castration levels with serum testosterone <0.5 ng/mL at Day 28 with a target castration rate of 90%. Injection sites were inspected by the investigator at every visit and reactions (ISRs) were proactively recorded. RESULTS The target castration rate was reached in Group 2 (97.5%) but not in Group 1 (62.5%). The castration rates were not maintained to Day 42 (Group 2: 82.5%; Group 1: 50.0%). Suppression of testosterone to castrate levels occurred rapidly (median time: 2 days for both groups). Suppression of testosterone, prostate-specific antigen, follicle-stimulating hormone, and luteinizing hormone was sustained throughout the treatment period, being more prominent with the higher dose. The adverse event (AE) profile was similar between groups. The most common AEs were injection-site induration (n = 40: 80.0%), injection-site erythema (n = 35: 70.0%), and hot flush (n = 21: 42.0%). Most ISRs were Grade 1. CONCLUSION Overall, the teverelix DP doses were generally well-tolerated but did not adequately maintain castration levels.
Collapse
Affiliation(s)
- Albertas Ulys
- Departments of Urology, National Cancer Institute, Vilnius, Lithuania
| | - Feliksas Jankevicus
- Faculty of Medicine, Departments of Urology, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Jievaltas
- Urology Department, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimundas Venckus
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Stasys Auskalnis
- Urology Department, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Marija Barisiene
- Faculty of Medicine, Departments of Urology, Vilnius University, Vilnius, Lithuania
| | | | | | | |
Collapse
|
24
|
Hong YR, Wang R, Case S, Jo A, Turner K, Ross KM. Association of food insecurity with overall and disease-specific mortality among cancer survivors in the US. Support Care Cancer 2024; 32:309. [PMID: 38664265 DOI: 10.1007/s00520-024-08495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. METHODS Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. RESULTS Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. CONCLUSIONS Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.
Collapse
Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Stuart Case
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
25
|
Parsa S, Saleh A, Raygor V, Hoeting N, Rao A, Navar AM, Rohatgi A, Kay F, Abbara S, Khera A, Joshi PH. Measurement and Application of Incidentally Detected Coronary Calcium: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1557-1567. [PMID: 38631775 DOI: 10.1016/j.jacc.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease risk stratification. The nongated, noncontrast chest computed tomography scan (NCCT) has emerged as a source of CAC characterization with tremendous potential due to the high volume of NCCT scans. Application of incidental CAC characterization from NCCT has raised questions around score accuracy, standardization of methodology including the possibility of deep learning to automate the process, and the risk stratification potential of an NCCT-derived score. In this review, the authors aim to summarize the role of NCCT-derived CAC in preventive cardiovascular health today as well as explore future avenues for eventual clinical applicability in specific patient populations and broader health systems.
Collapse
Affiliation(s)
- Shyon Parsa
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA; Department of Internal Medicine, Stanford University Hospital, Stanford, California, USA
| | - Adam Saleh
- Texas A&M University, Engineering Medicine, Houston, Texas, USA
| | - Viraj Raygor
- Sutter Health, Cardiovascular Health, Palo Alto, California, USA
| | - Natalie Hoeting
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anjali Rao
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Kay
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
26
|
Chan JSK, Chan RNC, Lee YHA, Satti DI, Dee EC, Ng K, Achim A, Ng CF, Liu T, Matthews GDK, Tse G, Vassiliou VS. Cardiovascular health of patients with cancer: Challenges abound. Trends Cardiovasc Med 2024:S1050-1738(24)00036-7. [PMID: 38657744 DOI: 10.1016/j.tcm.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Patients with cancer have elevated cardiovascular risks compared to those without cancer. As cancer incidence increases and cancer-related mortality decreases, cardiovascular diseases in patients with a history of cancer will become increasingly important. This in turn is reflected by the exponentially increasing amount of cardio-oncology research in recent years. This narrative review aims to summarize the key existing literature in several main areas of cardio-oncology, including the epidemiology, natural history, prevention, management, and determinants of the cardiovascular health of patients with cancer, and identify relevant gaps in evidence for further research.
Collapse
Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Raymond Ngai Chiu Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenrick Ng
- Department of Medical Oncology, Barts Cancer Centre, London, UK
| | - Alexandru Achim
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary; Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Gareth D K Matthews
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China; Kent and Medway Medical School, Canterbury, Kent CT2 7NT, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, PR China.
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
| |
Collapse
|
27
|
Zhang M, Lotfollahzadeh S, Elzinad N, Yang X, Elsadawi M, Gower AC, Belghasem M, Shazly T, Kolachalama VB, Chitalia VC. Alleviating iatrogenic effects of paclitaxel via antiinflammatory treatment. Vasc Med 2024:1358863X241231942. [PMID: 38623630 DOI: 10.1177/1358863x241231942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Paclitaxel (PTX) is touted as an essential medicine due to its extensive use as a chemotherapeutic agent for various cancers and an antiproliferative agent for endovascular applications. Emerging studies in cardio-oncology implicate various vascular complications of chemotherapeutic agents. METHODS We evaluated the inflammatory response induced by the systemic administration of PTX. The investigation included RNAseq analysis of primary human endothelial cells (ECs) treated with PTX to identify transcriptional changes in pro-inflammatory mediators. Additionally, we used dexamethasone (DEX), a well-known antiinflammatory compound, to assess its effectiveness in counteracting these PTX-induced changes. Further, we studied the effects of PTX on monocyte chemoattractant protein-1 (MCP-1) levels in the media of ECs. The study also extended to in vivo analysis, where a group of mice was injected with PTX and subsequently harvested at different times to assess the immediate and delayed effects of PTX on inflammatory mediators in blood and aortic ECs. RESULTS Our RNAseq analysis revealed that PTX treatment led to significant transcriptional perturbations in pro-inflammatory mediators such as MCP-1 and CD137 within primary human ECs. These changes were effectively abrogated when DEX was administered. In vitro experiments showed a marked increase in MCP-1 levels in EC media following PTX treatment, which returned to baseline upon treatment with DEX. In vivo, we observed a threefold increase in MCP-1 levels in blood and aortic ECs 12 h post-PTX administration. Similar trends were noted for CD137 and other downstream mediators like tissue factor, vascular cell adhesion molecule 1, and E-selectin in aortic ECs. CONCLUSION Our findings illustrate that PTX exposure induces an upregulation of atherothrombotic mediators, which can be alleviated with concurrent administration of DEX. Considering these observations, further long-term investigations should focus on understanding the systemic implications associated with PTX-based therapies and explore the clinical relevance of DEX in mitigating such risks.
Collapse
Affiliation(s)
- Mengwei Zhang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Saran Lotfollahzadeh
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Nagla Elzinad
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Xiaosheng Yang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Murad Elsadawi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Adam C Gower
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Clinical and Translational Science Institute, Boston University School of Medicine, Boston, MA, USA
| | - Mostafa Belghasem
- Department of Biomedical Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Tarek Shazly
- College of Engineering & Computing, University of South Carolina, Columbia, SC, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Vipul C Chitalia
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
28
|
Wilcox NS, Amit U, Reibel JB, Berlin E, Howell K, Ky B. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol 2024:10.1038/s41569-024-01017-x. [PMID: 38600368 DOI: 10.1038/s41569-024-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.
Collapse
Affiliation(s)
- Nicholas S Wilcox
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Uri Amit
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob B Reibel
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kendyl Howell
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
29
|
Zmaili M, Alzubi J, Alkhayyat M, Albakri A, Alkhalaileh F, Longinow J, Moudgil R. Cancer and Cardiovascular Disease: The Conjoined Twins. Cancers (Basel) 2024; 16:1450. [PMID: 38672532 PMCID: PMC11048405 DOI: 10.3390/cancers16081450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer and cardiovascular disease are the two most common causes of death worldwide. As the fields of cardiovascular medicine and oncology continue to expand, the area of overlap is becoming more prominent demanding dedicated attention and individualized patient care. We have come to realize that both fields are inextricably intertwined in several aspects, so much so that the mere presence of one, with its resultant downstream implications, has an impact on the other. Nonetheless, cardiovascular disease and cancer are generally approached independently. The focus that is granted to the predominant pathological entity (either cardiovascular disease or cancer), does not allow for optimal medical care for the other. As a result, ample opportunities for improvement in overall health care are being overlooked. Herein, we hope to shed light on the interconnected relationship between cardiovascular disease and cancer and uncover some of the unintentionally neglected intricacies of common cardiovascular therapeutics from an oncologic standpoint.
Collapse
Affiliation(s)
- Mohammad Zmaili
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Jafar Alzubi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Motasem Alkhayyat
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Almaza Albakri
- Jordanian Royal Medical Services, Department of Internal Medicine, King Abdullah II Ben Al-Hussein Street, Amman 11855, Jordan
| | - Feras Alkhalaileh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Joshua Longinow
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Rohit Moudgil
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
30
|
Sayour NV, Paál ÁM, Ameri P, Meijers WC, Minotti G, Andreadou I, Lombardo A, Camilli M, Drexel H, Grove EL, Dan GA, Ivanescu A, Semb AG, Savarese G, Dobrev D, Crea F, Kaski JC, de Boer RA, Ferdinandy P, Varga ZV. Heart failure pharmacotherapy and cancer: pathways and pre-clinical/clinical evidence. Eur Heart J 2024; 45:1224-1240. [PMID: 38441940 PMCID: PMC11023004 DOI: 10.1093/eurheartj/ehae105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/08/2024] [Accepted: 02/07/2024] [Indexed: 04/08/2024] Open
Abstract
Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided.
Collapse
Affiliation(s)
- Nabil V Sayour
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- HCEMM-SU Cardiometabolic Immunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
- MTA-SE Momentum Cardio-Oncology and Cardioimmunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
| | - Ágnes M Paál
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiology Network, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Wouter C Meijers
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giorgio Minotti
- University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Ioanna Andreadou
- Laboratory of Pharmacology, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonella Lombardo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gheorghe Andrei Dan
- Carol Davila University of Medicine and Pharmacy, Colentina University Hospital, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andreea Ivanescu
- Carol Davila University of Medicine and Pharmacy, Colentina University Hospital, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Anne Grete Semb
- Division of Research and Innovation, REMEDY-Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Juan-Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- Pharmahungary Group, Szeged, Hungary
- MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Zoltán V Varga
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- HCEMM-SU Cardiometabolic Immunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
- MTA-SE Momentum Cardio-Oncology and Cardioimmunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
| |
Collapse
|
31
|
Shen R, Zou T. Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999-2018. Cardiovasc Toxicol 2024; 24:351-364. [PMID: 38466544 DOI: 10.1007/s12012-024-09845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
There is a dearth of evidence pertaining to the relationship of cardiovascular disease (CVD) and its subtype with adjudicated cancer, thereby limiting our understanding of the heightened risk of CVD resulting from long-term complications of cancer and its therapies. The aim of this study was to quantify the risks of CVD and its subtypes in adult cancer survivors compared with cancer-free controls in a nationwide cross-sectional study on Continuous National Health and Nutrition Examination Survey (NHANES). We included 44,442 participants ranging in age from 20 to 85 years. Cancer and CVD diagnoses were ascertained via the household questionnaires. The association of cancer status with the risk of CVD and CVD subtype was examined using weighted logistic regression. Stratification analyses were also performed by age, sex, race, marital status, income status, educational level, and hyperlipidemia. The Wald test was used to calculate P-value for interaction. A total of 4178 participants have cancer, while 4829 participants had CVD, respectively. In the multivariable-adjusted model, the cancer was consistently linked to an elevated risk of CVD. Stratification analyses showed that stronger association between cancer status and CVD risk was found in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. Our study confirmed that cancer participants were strongly linked to living with CVD, independent of traditional cardiovascular risk factors, especially in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. There exists a pressing requirement to establish effective strategies for the prevention of CVD within this population characterized by a heightened risk.
Collapse
Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| |
Collapse
|
32
|
Egan BM, Mattix-Kramer HJ, Basile JN, Sutherland SE. Managing Hypertension in Older Adults. Curr Hypertens Rep 2024; 26:157-167. [PMID: 38150080 PMCID: PMC10904451 DOI: 10.1007/s11906-023-01289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE OF REVIEW The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease. RECENT FINDINGS Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.
Collapse
Affiliation(s)
- Brent M Egan
- American Medical Association, Improving Health Outcomes, 2 West Washington Street, Suite 601, Greenville, SC, 29601, USA.
| | - Holly J Mattix-Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago Loyola University Medical Center, Maywood, IL, USA
| | - Jan N Basile
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Susan E Sutherland
- American Medical Association, Improving Health Outcomes, 2 West Washington Street, Suite 601, Greenville, SC, 29601, USA
| |
Collapse
|
33
|
Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
Collapse
Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
34
|
Shaikh PA, Som A, Deych E, Deng AJ, Reimers MA, Baumann BC, Kim EH, Lenihan DJ, Zhang KW. Incidental Coronary Arterial Calcification for Cardiovascular Risk Assessment in Men With Prostate Cancer Undergoing PET/CT Imaging. Clin Genitourin Cancer 2024; 22:586-592. [PMID: 38369389 DOI: 10.1016/j.clgc.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Cardiovascular (CV) disease is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting. METHODS Consecutive patients who underwent positron emission tomography/computed tomography (PET/CT) for recurrent prostate cancer at a single institution from 2012 to 2017 were identified retrospectively. Clinical data and coronary calcification on nongated CT imaging were obtained. The primary outcome was major adverse CV event (MACE; myocardial infarction, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality) occurring within 5 years of PET/CT. RESULTS Among 354 patients included in the study, there were 98 MACE events that occurred in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%). Coronary calcification was predictive of MACE (HR = 1.9, 95% CI: 1.1-3.4, P = .03) using adjusted Kaplan-Meier analysis. As a comparator, the Framingham risk score was calculated for 198 patients (56%) with complete clinical and laboratory data available. In this subgroup, high baseline Framingham risk (corresponding to 10-year risk of CV disease > 20%) was not predictive of MACE. CONCLUSIONS MACE was common (21%) in men with recurrent prostate cancer undergoing PET/CT over 5 years of follow-up. Incidental coronary calcification on PET/CT was associated with increased risk of MACE and may have utility as a CV risk predictor that is feasible to implement among all prostate cancer providers.
Collapse
Affiliation(s)
- Preet A Shaikh
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Avira Som
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Elena Deych
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Alison J Deng
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Melissa A Reimers
- Division of Oncology, Section of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO
| | | | - Kathleen W Zhang
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
35
|
Henriksson A, Elfström ML, Söderlund A, von Heideken Wågert P. Exploring sedentary behavior during neo- or adjuvant treatment in patients with cancer: A phenomenological study. Eur J Oncol Nurs 2024; 70:102556. [PMID: 38636117 DOI: 10.1016/j.ejon.2024.102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment. METHODS Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior. RESULTS The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image. CONCLUSIONS Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.
Collapse
Affiliation(s)
- Anna Henriksson
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden.
| | - Magnus L Elfström
- School of Health, Care and Social Welfare, Division of Psychology, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Petra von Heideken Wågert
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| |
Collapse
|
36
|
Guan T, Monteiro O, Chen D, Luo Z, Chi K, Li Z, Liang Y, Lu Z, Jiang Y, Yang J, Lin W, Yi M, Zhang K, Ou C. Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers. J Adv Res 2024:S2090-1232(24)00117-6. [PMID: 38537701 DOI: 10.1016/j.jare.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/05/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers. OBJECTIVES To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites. METHODS A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs). RESULTS In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]-19·85[95 %CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]-19·25[95 %CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]-24·71[95 %CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group. CONCLUSION The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.
Collapse
Affiliation(s)
- Tianwang Guan
- Cancer Center, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China
| | - Olivia Monteiro
- Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China
| | - Dongting Chen
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Zehao Luo
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Kaiyi Chi
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhihao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Yinglan Liang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Zhenxing Lu
- The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China
| | - Yanting Jiang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Jinming Yang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Wenrui Lin
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Min Yi
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510180, China
| | - Kang Zhang
- Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China.
| | - Caiwen Ou
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China.
| |
Collapse
|
37
|
Modica R, La Salvia A, Liccardi A, Cozzolino A, Di Sarno A, Russo F, Colao A, Faggiano A. Dyslipidemia, lipid-lowering agents and neuroendocrine neoplasms: new horizons. Endocrine 2024:10.1007/s12020-024-03767-7. [PMID: 38509261 DOI: 10.1007/s12020-024-03767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Neuroendocrine neoplasms (NENs) are a heterogeneous group of malignancies originating from cells with a neuroendocrine phenotype. The complex relationship between lipid metabolism and cancer is gaining interest and a potential anti-cancer effect of lipid lowering agents is being considered. This review aims to discuss the current understanding and treatment of dyslipidaemia in NENs, focusing on the role of lipid lowering agents, including new therapeutic approaches, and future perspectives as possible tool in cancer prevention and tumor-growth control. METHODS We performed an electronic-based search using PubMed updated until December 2023, summarizing the available evidence both in basic and clinical research about lipid lowering agents in NENs. RESULTS Dyslipidemia is an important aspect to be considered in NENs management, although randomized studies specifically addressing this topic are lacking, unlike other cancer types. Available data mainly regard statins, and in vitro studies have demonstrated direct antitumor effects, including antiproliferative effects in some cancers, supporting possible pleiotropic effects also in NENs, but data remain conflicting. Ezetimibe, omega 3-fatty acids, fibrates and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) may enhance the regulation of lipid homeostasis, as demonstrated in other cancers. CONCLUSIONS Targeting dyslipidemia in NENs should be part of the multidisciplinary management and an integrated approach may be the best option for both metabolic and tumor control. Whether lipid lowering agents may directly contribute to tumor control remains to be confirmed with specific studies, focusing on association with other metabolic risk, disease stage and primary site.
Collapse
Affiliation(s)
- Roberta Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy.
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161, Rome, Italy
| | - Alessia Liccardi
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
| | - Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Antonella Di Sarno
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
| | - Flaminia Russo
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189, Rome, Italy
| | - Annamaria Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, 80131, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189, Rome, Italy
| |
Collapse
|
38
|
Zhang YL, Liu ZR, Liu Z, Bai Y, Chi H, Chen DP, Zhang YM, Cui ZL. Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model. World J Gastrointest Oncol 2024; 16:844-856. [PMID: 38577452 PMCID: PMC10989395 DOI: 10.4251/wjgo.v16.i3.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common types of cancers worldwide, ranking fifth among men and seventh among women, resulting in more than 7 million deaths annually. With the development of medical technology, the 5-year survival rate of HCC patients can be increased to 70%. However, HCC patients are often at increased risk of cardiovascular disease (CVD) death due to exposure to potentially cardiotoxic treatments compared with non-HCC patients. Moreover, CVD and cancer have become major disease burdens worldwide. Thus, further research is needed to lessen the risk of CVD death in HCC patient survivors. AIM To determine the independent risk factors for CVD death in HCC patients and predict cardiovascular mortality (CVM) in HCC patients. METHODS This study was conducted on the basis of the Surveillance, Epidemiology, and End Results database and included HCC patients with a diagnosis period from 2010 to 2015. The independent risk factors were identified using the Fine-Gray model. A nomograph was constructed to predict the CVM in HCC patients. The nomograph performance was measured using Harrell's concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and area under the ROC curve (AUC) value. Moreover, the net benefit was estimated via decision curve analysis (DCA). RESULTS The study included 21545 HCC patients, of whom 619 died of CVD. Age (< 60) [1.981 (1.573-2.496), P < 0.001], marital status (married) [unmarried: 1.370 (1.076-1.745), P = 0.011], alpha fetoprotein (normal) [0.778 (0.640-0.946), P = 0.012], tumor size (≤ 2 cm) [(2, 5] cm: 1.420 (1.060-1.903), P = 0.019; > 5 cm: 2.090 (1.543-2.830), P < 0.001], surgery (no) [0.376 (0.297-0.476), P < 0.001], and chemotherapy(none/unknown) [0.578 (0.472-0.709), P < 0.001] were independent risk factors for CVD death in HCC patients. The discrimination and calibration of the nomograph were better. The C-index values for the training and validation sets were 0.736 and 0.665, respectively. The AUC values of the ROC curves at 2, 4, and 6 years were 0.702, 0.725, 0.740 in the training set and 0.697, 0.710, 0.744 in the validation set, respectively. The calibration curves showed that the predicted probabilities of the CVM prediction model in the training set vs the validation set were largely consistent with the actual probabilities. DCA demonstrated that the prediction model has a high net benefit. CONCLUSION Risk factors for CVD death in HCC patients were investigated for the first time. The nomograph served as an important reference tool for relevant clinical management decisions.
Collapse
Affiliation(s)
- Yu-Liang Zhang
- First Central Clinical College, Tianjin Medical University, Tianjin 300070, China
| | - Zi-Rong Liu
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Zhi Liu
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Yi Bai
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Hao Chi
- First Central Clinical College, Tianjin Medical University, Tianjin 300070, China
| | - Da-Peng Chen
- First Central Clinical College, Tianjin Medical University, Tianjin 300070, China
| | - Ya-Min Zhang
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Zi-Lin Cui
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| |
Collapse
|
39
|
Zheng X, Liu Z, Bin Y, Wang J, Rao X, Wu G, Dong X, Tong F. Ionizing radiation induces vascular smooth muscle cell senescence through activating NF-κB/CTCF/p16 pathway. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166994. [PMID: 38141838 DOI: 10.1016/j.bbadis.2023.166994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/25/2023]
Abstract
Radiation injury of blood vessels (RIBV) is a serious long-term complication of radiotherapy, characterized by the development of atherosclerosis. The involvement of vascular smooth muscle cells (VSMCs) senescence in the pathogenesis of radiation-induced atherosclerosis has been implicated, yet the precise mechanisms governing VSMCs senescence remain inadequately comprehended. In this study, the senescence of VSMCs was examined by employing SA-β-gal staining and assessing the expression of p16 and p21, both in vivo and in vitro. Our findings revealed that ionizing radiation (IR) has the potential to augment cellular senescence. In addition, IR significantly activated the NF-κB pathway, as evidenced by increased p65 nuclear translocation, phospho-p65 expression, and enhanced binding ability of p65 (EMSA). Furthermore, a decrease in HMGB2 expression following exposure to IR was observed via Western blot analysis, while CTCF expression remained unchanged. Interestingly, the formation of CTCF spatial clustering was detected under super-resolution fluorescence microscopy. Concurrently, the ChIP technique identified the facilitation of the interaction between CTCF and p16 gene through IR. The inhibition of CTCF or the overexpression of HMGB2 through lentiviruses effectively eliminates the formation of CTCF clusters and the upregulation of p16 and p21 after IR. Inhibition of NF-κB activation induced by IR by PDTC (100 μM) led to a decrease in the staining of SA-β-gal, a reduction in p16 expression, an increase in HMGB2 protein expression and a decrease in CTCF clusters formation. This study provided significant insights into the role and mechanism of IR in VSMCs senescence by regulating NF-κB/CTCF/p16 pathway.
Collapse
Affiliation(s)
- Xuefeng Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhiwei Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan 430022, China
| | - Yawen Bin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiaojiao Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xinrui Rao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan 430022, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Xiaorong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Fan Tong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| |
Collapse
|
40
|
Li W, Wang Z, Jiang C, Hua C, Tang Y, Zhang H, Liu X, Zheng S, Wang Y, Gao M, Lv Q, Dong J, Ma C, Du X. Effect of Intensive Blood Pressure Control on Cardiovascular Outcomes in Cancer Survivors. Hypertension 2024; 81:620-628. [PMID: 38164752 DOI: 10.1161/hypertensionaha.123.22194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND To evaluate whether cancer modifies the effect of intensive blood pressure control on major cardiovascular outcomes. METHODS Using data of the SPRINT (Systolic Blood Pressure Intervention Trial), we compared the risk of the composite outcomes of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death in patients with and without a history of cancer. Using Cox proportional hazards regression, we tested interactions between history of cancer and intensive blood pressure control on major cardiovascular outcomes. RESULTS The study included a total of 9336 patients, with a mean age of 67.9±9.4 years, among whom 2066 (22.2%) were cancer survivors. Over a median follow-up of 3.2 years, 561 primary cardiovascular outcomes were observed. Cancer survivors had a similar risk of experiencing the primary outcome compared with patients without cancer after multivariable adjustment (adjusted hazard ratio, 0.94 [95% CI, 0.77-1.15]). Intensive blood pressure control reduced risk of the primary cardiovascular outcome similarly for cancer survivors (hazard ratio, 0.70 [95% CI, 0.51-0.97]) and patients without cancer (HR, 0.76 [95% CI, 0.63-0.93]; P for interaction 0.74). CONCLUSIONS In SPRINT study, intensive blood pressure treatment reduced the risk of major cardiovascular events in cancer survivors to a similar extent to that of patients without cancer. Cancer history not requiring active treatment in last 2 years should not be an obstacle to intensive treatment of hypertension. This post hoc analysis should be considered as hypothesis-generating and merit further clinical trial. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
Collapse
Affiliation(s)
- Wenjie Li
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Chang Hua
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Yangyang Tang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Hao Zhang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Shiyue Zheng
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Yufeng Wang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Mingyang Gao
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.)
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.)
- Heart Health Research Center, Beijing, China (X.D.)
- George Institute for Global Health, Australia (X.D.)
- The University of New South Wales, Sydney, Australia (X.D.)
| |
Collapse
|
41
|
Hurst ZA, Liyanarachchi S, Brock P, He H, Nabhan F, Veloski C, Toland AE, Ringel MD, Jhiang SM. Presumed Pathogenic Germ Line and Somatic Variants in African American Thyroid Cancer. Thyroid 2024; 34:378-387. [PMID: 38062767 PMCID: PMC10951570 DOI: 10.1089/thy.2023.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: African American (AA) thyroid cancer patients have worse prognoses than European Americans (EA), which has been attributed to both health care disparities and possible genetic differences. We investigated the impact of both germ line and somatic variants on clinical outcome in a cohort of AA nonmedullary thyroid cancer (NMTC) patients who had received therapeutic intervention from cancer centers. Methods: Whole-exome sequencing was performed on DNA from available blood/normal tissues (N = 37) and paired tumor samples (N = 32) collected from 37 and 29 AA NMTC patients, respectively. Variants with Combined Annotation Depletion Dependent (CADD) score of ≥20 and VarSome Clinical classification of likely pathogenic or pathogenic were classified as presumed pathogenic germ line or somatic variants (PPGVs/PPSVs). PPGVs/PPSVs in cancer-related genes and PPGVs in cardiovascular risk genes were further investigated, and PPGVs/PPSVs associated with African (AFR) ancestry were identified. Results: Among 17 PPGVs identified in 16 cancer predisposition or known cancer-related genes, only WRN was previously known to associate with NMTC predisposition. Among PPSVs, BRAFV600E was most the prevalent and detected in 12 of the 29 (41%) tumors. Examining PPGVs/PPSVs among three patients who died from NMTC, one patient who died from papillary thyroid carcinoma/anaplastic thyroid carcinoma (PTC/ATC) led us to speculate that the PPGV ERCC4R799W may have increased the risk of PPSV TP53R273H acquisition. Among PPGVs identified in 18 cardiovascular risk genes, PPGVs in SC5NA, GYG1, CBS, CFTR, and SI are known to have causal and pathogenic implications in cardiovascular disease. Conclusion: In this cohort, most AA-NMTC patients exhibit favorable outcomes after therapeutic intervention given at cancer centers, suggesting that health care disparity is the major contributor for worse prognoses among AA-NMTC patients. Nevertheless, the clinical impact of PPGVs that might facilitate the acquisition of TP53 tumor mutations, and/or PPGVs that predispose individuals to adverse cardiovascular events, which could be exacerbated by therapy-induced cardiotoxicity, needs to be further explored. Integrated analysis of PPGV/PPSV profiles among NMTC patients with different stages of disease may help to identify NMTC patients who require close monitoring or proactive intervention.
Collapse
Affiliation(s)
- Zachary A. Hurst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sandya Liyanarachchi
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Pamela Brock
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Huiling He
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Colleen Veloski
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Cancer Biology and Genetics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D. Ringel
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sissy M. Jhiang
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
42
|
Mani K, Deng D, Lin C, Wang M, Hsu ML, Zaorsky NG. Causes of death among people living with metastatic cancer. Nat Commun 2024; 15:1519. [PMID: 38374318 PMCID: PMC10876661 DOI: 10.1038/s41467-024-45307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Studying survivorship and causes of death in patients with advanced or metastatic cancer remains an important task. We characterize the causes of death among patients with metastatic cancer, across 13 cancer types and 25 non-cancer causes and predict the risk of death after diagnosis from the diagnosed cancer versus other causes (e.g., stroke, heart disease, etc.). Among 1,030,937 US (1992-2019) metastatic cancer survivors, 82.6% of patients (n = 688,529) died due to the diagnosed cancer, while 17.4% (n = 145,006) died of competing causes. Patients with lung, pancreas, esophagus, and stomach tumors are the most likely to die of their metastatic cancer, while those with prostate and breast cancer have the lowest likelihood. The median survival time among patients living with metastases is 10 months; our Fine and Gray competing risk model predicts 1 year survival with area under the receiver operating characteristic curve of 0.754 (95% CI [0.754, 0.754]). Leading non-cancer deaths are heart disease (32.4%), chronic obstructive and pulmonary disease (7.9%), cerebrovascular disease (6.1%), and infection (4.1%).
Collapse
Affiliation(s)
- Kyle Mani
- Albert Einstein School of Medicine, Bronx, NY, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daxuan Deng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Melinda L Hsu
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| |
Collapse
|
43
|
Dindinger-Hill K, Hu S, Hickman A, Choudry M, Vehawn J, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Kohli M, O'Neil B, Schmidt B, Dechet C, Hashibe M, Sanchez A. Association of Baseline Pre-Diagnosis and Post-Diagnosis Obesity and Weight Change with Cardiovascular Risk and Survival Among Nonmetastatic Prostate Cancer Survivors. Clin Genitourin Cancer 2024:102057. [PMID: 38503572 DOI: 10.1016/j.clgc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Obesity in prostate cancer survivors may increase mortality. Better characterization of this effect may allow better counseling on obesity as a targetable lifestyle factor to reduce mortality in prostate cancer survivors. The purpose of this study was to determine whether pre- and post-diagnostic obesity and weight change affect all-cause mortality, cardiovascular disease specific mortality, and prostate cancer specific mortality in patients with nonmetastatic prostate cancer. PATIENTS AND METHODS We performed a retrospective cohort analysis of 5,077 patients diagnosed with localized prostate cancer from 1997 to 2017 with median follow-up of 15.5 years. The Utah Population Database linked to the Utah Cancer Registry was used to identify patients at a variety of treatment centers. RESULTS Pre-diagnosis obesity was associated with a 62% increased risk of cardiovascular disease specific mortality and a 34% increased risk of all-cause mortality (HR 1.62, 95% CI 1.05-2.50; HR 1.34, 95% CI 1.07-1.67, respectively). Post-diagnosis obesity increased the risk of cardiovascular disease specific mortality (HR 1.83, 95% CI 1.31-2.56) and all-cause mortality (HR 1.37, 95% CI 1.16-1.64) relative to non-obese men. We found no association between pre-diagnostic obesity or post-diagnostic weight gain and prostate cancer specific mortality. CONCLUSION Our study strengthens the conclusion that pre-, post-diagnostic obesity and weight gain increase cardiovascular disease and all-cause mortality but not prostate cancer specific mortality compared to healthy weight men. An increased emphasis on weight management may improve mortality for prostate cancer survivors who are obese.
Collapse
Affiliation(s)
| | - Siqi Hu
- Huntsman Cancer Institute, Salt Lake City, UT; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | | | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Manish Kohli
- Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | | | | | | | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | |
Collapse
|
44
|
Liu L, Xiao Y, Wei D, Wang Q, Zhang JK, Yuan L, Bai GQ. Development and validation of a nomogram for predicting suicide risk and prognostic factors in bladder cancer patients following diagnosis: A population-based retrospective study. J Affect Disord 2024; 347:124-133. [PMID: 38000463 DOI: 10.1016/j.jad.2023.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
This study sought to identify independent risk factors associated with suicide following a diagnosis of bladder cancer and to develop a predictive model with the potential to contribute to suicide rate reduction. Harnessing data from the Surveillance, Epidemiology, and End Results (SEER) database, we identified bladder cancer patients diagnosed between 2004 and 2015, randomly assigning them to training and validation cohorts. The Cox proportional hazard model was employed to identify relevant predictors, leading to the construction of prediction nomogram models. Validation of prognostic nomograms involved assessing the consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. A total of 109,961 eligible bladder cancer patients were enrolled, randomly divided into training and validation sets. Multivariate Cox regression analysis revealed that sex, marital status, tumor local status (T Stage), and lymph node metastatic conditions (N Stage) were independent predictors for suicide in bladder cancer patients. Evaluation of the nomogram's accuracy through the C-index and ROC curve demonstrated acceptable performance in both training and validation sets. Moreover, the calibration plot indicated moderate accuracy of the nomogram in both datasets. Overall, this study successfully identified risk factors for suicide among bladder cancer patients and developed a nomogram, offering individualized diagnosis, intervention, and risk assessment to mitigate the risk of suicide in this patient population.
Collapse
Affiliation(s)
- Liang Liu
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China; Prostate & Andrology Key Laboratory of Baoding, Baoding 071000, Hebei, China.
| | - Yu Xiao
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu 610036, Sichuan, China; Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610036, Sichuan, China
| | - Dong Wei
- Department of Surgery and Urology, Hebei General Hospital, Shijiazhuang 050051, China
| | - Qiang Wang
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China; Prostate & Andrology Key Laboratory of Baoding, Baoding 071000, Hebei, China
| | - Jin-Ku Zhang
- Department of Pathology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Lei Yuan
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Gui-Qing Bai
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| |
Collapse
|
45
|
Han W, Wang W, Wang Q, Maduray K, Hao L, Zhong J. A review on regulation of DNA methylation during post-myocardial infarction. Front Pharmacol 2024; 15:1267585. [PMID: 38414735 PMCID: PMC10896928 DOI: 10.3389/fphar.2024.1267585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Myocardial infarction (MI) imposes a huge medical and economic burden on society, and cardiac repair after MI involves a complex series of processes. Understanding the key mechanisms (such as apoptosis, autophagy, inflammation, and fibrosis) will facilitate further drug development and patient treatment. Presently, a substantial body of evidence suggests that the regulation of epigenetic processes contributes to cardiac repair following MI, with DNA methylation being among the notable epigenetic factors involved. This article will review the research on the mechanism of DNA methylation regulation after MI to provide some insights for future research and development of related drugs.
Collapse
Affiliation(s)
- Wenqiang Han
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenxin Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qinhong Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Li Hao
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| |
Collapse
|
46
|
He D, Qin K, Li J, Li Y, Chen Z, Xu J, Zhu Y. Increased incidence risks of cardiovascular disease among cancer patients: Evidence from a population-based cohort study in China. Int J Cardiol 2024; 396:131362. [PMID: 37722455 DOI: 10.1016/j.ijcard.2023.131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is becoming a major concern among cancer patients, leading to the development of a new field named cardio-oncology. However, previous studies were mainly based on the western population and focused on CVD mortality. Evidence from the Chinese population is limited. Furthermore, few studies investigated the incidence risks of CVD among cancer patients. METHODS 85,787 eligible cancer patients were included from Hangzhou city, China. Age-standardized standard incidence ratio (SIR) was used to reflect the incidence risks of CVD among cancer patients as compared with the standard population, which was defined as all residents in Hangzhou city during the same period. RESULTS After three years of follow-up, cancer patients showed elevated incidence risks of CVD (SIR = 1.41, 95%CI: 1.35-1.47) as compared with the standard population. The elevated risks of CVD were highest in the first year after cancer diagnosis (SIR = 1.68, 95%CI: 1.58-1.78), then followed by the second (SIR = 1.21, 95%CI: 1.11-1.31) and the third (SIR = 1.18, 95%CI: 1.07-1.29) year. These results were consistent in males and females. Furthermore, different risks of CVD were observed among different cancer sites. Patients with pancreatic cancer showed the highest risks of CVD, then followed by liver cancer, lung cancer, kidney cancer, gastric cancer, bladder cancer, prostate cancer, and colorectal cancer. CONCLUSIONS Cancer patients have increased incidence risks of CVD, especially in the first year after cancer diagnosis. The increased risks of CVD vary by different cancer sites. Our findings highlight the importance of paying close attention to the CVD risks among cancer patients.
Collapse
Affiliation(s)
- Di He
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kang Qin
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Jun Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuhao Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaohui Chen
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
47
|
Dafaalla M, Abramov D, Van Spall HG, Ghosh AK, Gale CP, Zaman S, Rashid M, Mamas MA. Heart Failure Readmission in Patients With ST-Segment Elevation Myocardial Infarction and Active Cancer. JACC CardioOncol 2024; 6:117-129. [PMID: 38510288 PMCID: PMC10950442 DOI: 10.1016/j.jaccao.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background Although numerous studies have examined readmission with heart failure (HF) after acute myocardial infarction (AMI), limited data are available on HF readmission in cancer patients post-AMI. Objectives This study aimed to assess the rates and factors associated with HF readmission in cancer patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods A nationally linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project registry and the UK national Hospital Episode Statistics Admitted Patient Care registry. Multivariable Fine-Gray competing risk models were used to evaluate HF readmission at 30 days and 1 year. Results A total of 326,551 STEMI indexed admissions were included, with 7,090 (2.2%) patients having active cancer. The cancer group was less likely to be admitted under the care of a cardiologist (74.5% vs 81.9%) and had lower rates of invasive coronary angiography (62.2% vs 72.7%; P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%). There was a significant prescription gap in the administration of post-AMI medications upon discharge such as an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (49.5% vs 71.1%) and beta-blockers (58.4% vs 68.0%) in cancer patients. The cancer group had a higher rate of HF readmission at 30 days (3.2% vs 2.3%) and 1 year (9.4% vs 7.3%). However, after adjustment, cancer was not independently associated with HF readmission at 30 days (subdistribution HR: 1.05; 95% CI: 0.86-1.28) or 1 year (subdistribution HR: 1.03; 95% CI: 0.92-1.16). The opportunity-based quality indicator was associated with higher rates of HF readmission independent of cancer diagnosis. Conclusions Cancer patients receive care that differs in important ways from patients without cancer. Greater implementation of evidence-based care may reduce HF readmissions, including in cancer patients.
Collapse
Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Loma Linda University International Heart Institute, Loma Linda, California, USA
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arjun K. Ghosh
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, London, United Kingdom
- Hatter Cardiovascular Institute, University College London Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
48
|
Zhang H, Xie H, Li L. Association of radioactive iodine treatment in differentiated thyroid cancer and cardiovascular death: a large population-based study. J Endocrinol Invest 2024; 47:443-453. [PMID: 37543985 DOI: 10.1007/s40618-023-02159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE The risk of cardiovascular diseases' death (CVD) in patients with differentiated thyroid cancer (DTC) treated with radioactive iodine (RAI) after surgery has not been adequately studied. METHODS Data of DTC patients who received RAI after surgery were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database (2004-2015). Standardized mortality rate (SMR) analysis was used to evaluate the CVD risk in patients with RAI vs general population. A 1:1 propensity score matching (PSM) was applied to balance inter-group bias, and Pearson's correlation coefficient was used to detect collinearity between variables. The Cox proportional hazard model and multivariate competing risk model were utilized to evaluate the impact of RAI on CVD. At last, we curved forest plots to compare differences in factors significantly associated with CVD or cancer-related deaths. RESULTS DTC patients with RAI treatment showed lower SMR for CVD than general population (RAI: SMR = 0.66, 95% CI 0.62-0.71, P < 0.05). After PSM, Cox proportional hazard regression demonstrated a decreased risk of CVD among patients with RAI compared to patients without (HR = 0.76, 95% CI 0.6-0.97, P = 0.029). However, in competing risk regression analysis, there was no significant difference (adjusted HR = 0.82, 95% CI 0.66-1.01, P = 0.11). The independent risk factors associated with CVD were different from those associated with cancer-related deaths. CONCLUSION The CVD risk between DTC patients treated with RAI and those who did not was no statistical difference. Noteworthy, they had decreased CVD risk compared with the general population.
Collapse
Affiliation(s)
- H Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - H Xie
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - L Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
| |
Collapse
|
49
|
Jiang C, Xu H, Wu Y. Effect of chemotherapy in tumor on coronary arteries: Mechanisms and management. Life Sci 2024; 338:122377. [PMID: 38135114 DOI: 10.1016/j.lfs.2023.122377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Coronary artery disease (CAD) is an important contributor to the cardiovascular burden in cancer survivors. The development of coronary ischemia events, myocardial infarction, and heart failure has been associated with many conventional chemotherapeutic agents, new targeted therapies, and immunotherapy. The most frequent pathological manifestations of chemotherapy-mediated coronary damage include acute vasospasm, acute thrombosis, accelerated atherosclerosis development, and microvascular dysfunction. Potential screening techniques for CAD patients include baseline risk factor evaluation, polygenic risk factors, and coronary artery calcium scores. Determining the risk requires consideration of both the type of chemotherapy and the type of cancer being treated. Cardiology-oncology guidelines offer some suggestions for the care of coronary artery disease, which might involve medication, lifestyle changes, and coronary revascularization.
Collapse
Affiliation(s)
- Chengqing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
50
|
Weaver KE, Dressler EV, Smith S, Nightingale CL, Klepin HD, Lee SC, Wells BJ, Hundley WG, DeMari JA, Price SN, Foraker RE. Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives. BMC Cancer 2024; 24:158. [PMID: 38297229 PMCID: PMC10829276 DOI: 10.1186/s12885-024-11912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. METHODS This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. RESULTS Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). CONCLUSIONS Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. TRIAL REGISTRATION NCT03935282, Registered 10/01/2020.
Collapse
Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, 417 N 11th St 4th Floor, Richmond, VA, 23219, USA
| | - Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO, 63110, USA
| |
Collapse
|