High cardiac biomarker levels linked to ‘significant’ mortality risk in cancer survivors
Click Here to Manage Email Alerts
Key takeaways:
- Cancer survivors with increased NT-proBNP levels had an elevated risk for all-cause and cardiac mortality.
- NT-proBNP levels may help guide the need for cardiac monitoring of survivors.
Cancer survivors with elevated levels of the protein N-terminal pro-brain natriuretic peptide had increased risk for death compared with adults without cancer, according to a study in Journal of the National Cancer Institute.
Overall, survivors had higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels than adults without cancer.
“We can use NT-proBNP to monitor cardiovascular health during cancer survivorship,” Chao Cao, PhD, MPH, research fellow at Dana-Farber Cancer Institute, told Healio.
There will be approximately 26 million cancer survivors in the United States by the year 2040, according to background information provided by researchers.
Improved detection and care has led to fewer cancer deaths, but treatments can cause other comorbidities, including cardiovascular disease (CVD).
“CVD and cancer share the same risk factors,” Cao said, including smoking, obesity and physical inactivity, according to the study.
“Cancer itself can also increase heart disease risk, particularly some chemotherapies,” he added.
Other studies have connected NT-proBNP to cardiovascular issues during cancer treatments, but Cao and colleagues aimed to determine whether long-term associations could be made regarding mortality.
They used the National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, to build their study cohort. NHANES monitors “the health and nutritional status of the U.S. population” in 2-year cycles, the study noted.
Researchers analyzed individuals aged at least 20 years from 1999 to 2004, including blood test results from samples taken between 2018 and 2020.
A total of 12,574 adults without cancer and 787 cancer survivors comprised the study cohort.
Cancer survivors had significantly higher median NT-proBNP levels compared with adults without cancer (median, 125.4 pg/mL vs. 43.2 pg/mL), offering more evidence supporting survivors being at increased risk for CVD.
Survivors of breast, prostate and colorectal cancer had noticeably higher median NT-proBNP levels, study results showed.
“Certain drugs can induce their cardiotoxicity,” Cao said.
Among cancer survivors, those above age 65 years, men, physically inactive individuals, and those with CVD and chronic kidney disease had elevated NT-proBNP levels.
Death occurred in 471 individuals — 141 of cancer and 95 of CVD.
Cancer survivors with increased NT-proBNP levels had an elevated risk for all-cause mortality (HR = 1.31; 95% CI, 1.18-1.46) and cardiac mortality (HR = 1.55; 95% CI, 1.21-2), but not cancer death.
“[Levels] higher than 125 (pg/ml) have significant increased risk for all-cause deaths, which is aligned with the American Heart Association guideline for the cutoff to define pre-heart failure,” Cao said. “If NT-proBNP levels are above this cut off, cancer survivors need to get more attention to their cardiovascular health.”
The study did have limits according to researchers, including NHANES not collecting cancer treatment data, and that cancer and CVD share risk factors.
“NT-proBNP could be a marker of pre-frailty and frailty, which are due to diseases that are common risks for both heart disease and cancer,” they wrote.
Cao wants future studies to examine whether certain drugs or lifestyle changes around diet and physical activity can lower NT-proBNP levels and reduce CVD risk in cancer survivors.
“The next step for the research is a [longitudinal study that] measures NT-proBNP before the cancer diagnosis, during the cancer diagnosis and after the cancer diagnosis, or maybe following every year to see whether the change in NT-proBNP links with the health outcome,” Cao said. “We can use NT-proBNP as targeting markers to do an intervention trial, or maybe a drug trial.”
In the meantime, measuring NT-proBNP levels may help clinicians identify cancer survivors who may need additional monitoring of their cardiovascular health.
“It is quite quick,” Cao said. “You can do the testing in most clinics.”
For more information:
Chao Cao, PhD, MPH, can be reached at chao_cao@dfci.harvard.edu.
Perspective
Back to Top
Patrick Collier, MD
This study by Cao and colleagues demonstrates that BNP can identify all-cause and cardiac mortality in an oncology cohort, and concurs with similar work at our institution, where we previously identified NT-pro-BNP as useful regarding cardiac risk stratification among patients with cancer (PMID: 34339408).
Simply put, cardiologists think of natriuretic peptides as a way of measuring “how happy is your heart.” They are the means in which your heart speaks — or shouts — to your kidneys to ask for help as part of a fascinating internal control system. If the heart feels stretched, it releases natriuretic peptides, which tell the kidney to lose salt, which drags fluid with it, and relieves the pressure or stretch that the heart felt to begin with. If your heart is happy, your BNP level will be normal. If your heart feels stretched or stressed, your BNP level will typically be high. In evolutionary terms, natriuretic peptides were likely particularly important for life in the salt-rich environment of our aquatic ancestors. Our modern understanding of natriuretic peptides has expanded, and we realize that these are the most important hormones the heart produces, and that they have many effects on the kidney, on the heart itself, and on the cardiovascular system in general.
To understand how well a particular biomarker may work in clinical practice as a practical screening test for individual patients, it always helps to apply Wilson’s 1968 general screening criteria or more recent iterations (PMID: 29632037). The main challenge is that BNP is a nonspecific signal. Many potential causes can trigger BNP elevation, so confounding is a clinical limitation, particularly if one invokes looking at temporal changes in BNP or serial testing.
Collapse
Click Here to Manage Email Alerts