Top Things to Know: Cardio-Oncology: Vascular & Metabolic Perspective
Published: February 21, 2019
- Many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications.
- Cancer serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events.
- Traditional cancer treatments have been associated with vascular complications and are unpredictable. New cancer therapies frequently target the interaction of cancer and the endothelium which may result in predictable vascular and metabolic sequelae. The intersection of cancer and cardiovascular disease (CVD) goes beyond pharmacology. Newer data suggest that common risk factors can underlie the pathogenesis of cancer and CVD. This can have significant public health implication as currently there are about 16 million Americans who are cancer survivors.
- This scientific statement highlights new paradigms in the field of cardio-oncology and brings forth many unanswered questions and future directions with special emphasis on “vascular cardio-oncology”.
- Despite the advent of targeted cancer agents and immunotherapies, traditional cytotoxic chemotherapies and radiation remain the mainstay of many cancer treatment protocols. Vascular complications (vascular injury and metabolic) of these traditional cancer therapies are discussed in this statement. These untoward effects increase the short and long-term risk of CV events beyond the already elevated risks often present in cancer patients and survivors.
- Targeted therapies have added significantly to the arsenal of treatment options for cancer patients. The vascular complications from these therapies are discussed in this statement.
- The link between metabolic dysregulation and CVD has been under studied for decades. This statement explores the metabolic complications of cancer therapies. Cancer itself represents a dysregulation of metabolism to promote cell growth and survival.
- Venous thrombosis, including superficial thrombophlebitis, deep venous thrombosis, in-dwelling catheter- associated thrombosis, and pulmonary embolus represents the most common CV complication of malignancy.
- Other risk factors common between cancer and CV disease include: hyperlipidemia, and genetic factors such as clonal hematopoiesis of indeterminate potential (CHIP).
- This scientific statement outlines how to structure a cardio-oncology service that provides comprehensive cardiovascular care to cancer survivors.
- Clinically optimal management of cancer patients and cancer survivors is ideally addressed by a multi-disciplinary approach, where CV medicine specialists work closely with oncologists to assess CV risk, minimize vascular toxicity, and manage long term adverse effects. Using this as a paradigm shift, this multidisciplinary approach will require cardio-oncology services with training of a new generation of CV specialists with an understanding of cancer treatments.
Citation
Campia U, Moslehi JJ, Amiri-Kordestani L, Barac A, Beckman JA, Chism DD, Cohen P, Groarke JD, Herrmann J, Reilly CM, Weintraub NL; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Cardiovascular and Stroke Nursing. Cardio-oncology: vascular and metabolic perspectives: a scientific statement from the American Heart Association [published online ahead of print February 21, 2019]. Circulation. doi: 10.1161/CIR.0000000000000641.