1
|
Yogeswaran V, Wadden E, Szewczyk W, Barac A, Simon MS, Eaton C, Cheng RK, Reding KW. A narrative review of heart failure with preserved ejection fraction in breast cancer survivors. Heart 2023:heartjnl-2022-321859. [PMID: 37258098 DOI: 10.1136/heartjnl-2022-321859] [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: 02/28/2023] [Accepted: 05/07/2023] [Indexed: 06/02/2023] Open
Abstract
Advances in breast cancer (BC) treatment have contributed to improved survival, but BC survivors experience significant short-term and long-term cardiovascular mortality and morbidity, including an elevated risk of heart failure with preserved ejection fraction (HFpEF). Most research has focused on HF with reduced ejection fraction (HFrEF) after BC; however, recent studies suggest HFpEF is the more prevalent subtype after BC and is associated with substantial health burden. The increased HFpEF risk observed in BC survivors may be explained by treatment-related toxicity and by shared risk factors that heighten risk for both BC and HFpEF. Beyond risk factors with physiological impacts that drive HFpEF risk, such as hypertension and obesity, social determinants of health (SDOH) likely contribute to HFpEF risk after BC, impacting diagnosis, management and prognosis.Increasing clinical awareness of HFpEF after BC and screening for cardiovascular (CV) risk factors, in particular hypertension, may be beneficial in this high-risk population. When BC survivors develop HFpEF, treatment focuses on initiating guideline-directed medical therapy and addressing underlying comorbidities with pharmacotherapy or behavioural intervention. HFpEF in BC survivors is understudied. Future directions should focus on improving HFpEF prevention and treatment by building a deeper understanding of HFpEF aetiology and elucidating contributing risk factors and their pathogenesis in HFpEF in BC survivors, in particular the association with different BC treatment modalities, including radiation therapy, chemotherapy, biological therapy and endocrine therapy, for example, aromatase inhibitors. In addition, characterising how SDOH intersect with these therapies is of paramount importance to develop future prevention and management strategies.
Collapse
Affiliation(s)
- Vidhushei Yogeswaran
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Elena Wadden
- Division of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Warren Szewczyk
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Ana Barac
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Michael S Simon
- Medical Oncology, Karmanos Cancer Center, Detroit, Michigan, USA
| | - Charles Eaton
- Family Medicine and Epidemiology Program, Brown University, Providence, Rhode Island, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| |
Collapse
|
2
|
Reding KW, Cheng RK, Barac A, Vasbinder A, Hovsepyan G, Stefanick M, Simon MS. Toward a Better Understanding of the Differential Impact of Heart Failure Phenotypes After Breast Cancer. J Clin Oncol 2022; 40:3688-3691. [PMID: 35687827 PMCID: PMC9649273 DOI: 10.1200/jco.22.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kerryn W. Reding
- University of Washington School of Nursing Biobehavioral Nursing and Health Informatics Department, Seattle, WA
- Fred Hutch Cancer Center Public Health Sciences Division, Seattle, WA
| | - Richard K. Cheng
- University of Washington School of Medicine, Department of Cardiology, Seattle, WA
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Alexi Vasbinder
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI
| | - Gayane Hovsepyan
- Barbara Ann Karmanos Cancer Institute, Department of Oncology, Detroit, MI
| | - Marcia Stefanick
- Stanford School of Medicine, Stanford Prevention Research Center, Palo Alto, CA
| | - Michael S. Simon
- Barbara Ann Karmanos Cancer Institute, Department of Oncology, Detroit, MI
| |
Collapse
|
3
|
Cardiovascular Consequences of Skeletal Muscle Impairments in Breast Cancer. Sports (Basel) 2020; 8:sports8060080. [PMID: 32486406 PMCID: PMC7353641 DOI: 10.3390/sports8060080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Breast cancer survivors suffer from disproportionate cardiovascular disease risk compared to age-matched controls. Beyond direct cardiotoxic effects due to treatments such as chemotherapy and radiation, breast-cancer-related reductions in skeletal muscle mass, quality and oxidative capacity may further contribute to cardiovascular disease risk in this population by limiting the ability to engage in aerobic exercise—a known promoter of cardiovascular health. Indeed, 20–30% decreases in peak oxygen consumption are commonly observed in breast cancer survivors, which are indicative of exercise intolerance. Thus, breast-cancer-related skeletal muscle damage may reduce exercise-based opportunities for cardiovascular disease risk reduction. Resistance training is a potential strategy to improve skeletal muscle health in this population, which in turn may enhance the capacity to engage in aerobic exercise and reduce cardiovascular disease risk.
Collapse
|
4
|
Kirkham AA, Beaudry RI, Paterson DI, Mackey JR, Haykowsky MJ. Curing breast cancer and killing the heart: A novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast cancer. Prog Cardiovasc Dis 2019; 62:116-126. [PMID: 30797800 DOI: 10.1016/j.pcad.2019.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 12/13/2022]
Abstract
Due to advances in prevention, early detection and treatment, early breast cancer mortality has decreased by nearly 40% during the last four decades. Yet, the risk of cardiovascular disease (CVD) mortality is significantly elevated following a breast cancer diagnosis, and it is a leading cause of death in this population. This review will discuss the most recent evidence for risks, pathology, mechanisms, and prevention of CVD morbidity and mortality in women with breast cancer. This evidence will be synthesized into a new model 'the compounding risk and protection model.' This model proposes that the balance between risk factors (i.e., older age, pre-existing traditional CVD risk factors and shared biologic pathways for CVD and cancer such as inflammation, as well as treatment-related and lifestyle toxicity) and potential protection factors (i.e., lifelong non-smoking, regular physical activity, a healthy diet rich in fruits and vegetables, and management of body weight and stress, heart failure therapy) determine the individual risk of CVD morbidity and mortality after diagnosis of early breast cancer.
Collapse
Affiliation(s)
- Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Rhys I Beaudry
- Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, USA
| | - D Ian Paterson
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - John R Mackey
- Department of Oncology, University of Alberta, Edmonton, Canada; Medical Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Mark J Haykowsky
- Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, USA.
| |
Collapse
|
5
|
Cancer and the Broken Heart: Complications and Implications of Therapy-Related Cardiotoxicity. JOURNAL OF INFUSION NURSING 2018; 41:229-240. [PMID: 29958259 DOI: 10.1097/nan.0000000000000285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The growing number of adult long-term cancer survivors has expanded our knowledge of negative physiologic sequelae associated with curative therapies. Of note are the cardiovascular corollaries of chest radiotherapy and some commonly used chemotherapy agents. A contemporary understanding of risk factors has facilitated the development of guidelines for prevention and surveillance of cardiac compromise. The future holds promise with enhanced opportunities to use cardioprotectant drugs and biomarkers to prevent and detect early myocardial changes. Infusion therapy nurses must keep abreast of these developments to facilitate their roles as patient educators and advocates in the face of this toxicity's prevalence.
Collapse
|
6
|
Shelburne N, Hammer M. Mitigating Cardiovascular Dysfunction Across the Cancer Continuum. Oncol Nurs Forum 2018; 45:15-17. [DOI: 10.1188/18.onf.15-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|