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For most cancer survivors, preventative CVD treatment, surveillance needed

LAS VEGAS — It is important for primary care doctors to understand the cardiovascular disease risks for cancer survivors and how to monitor those risks given that there are more than 13 million cancer survivors in the United States, according to a cardiologist here at the Cardiometabolic Risk Summit.

Cardiovascular disease is the leading cause of death in the U.S. population in both men and women.

“Unfortunately in the population of young women aged less than 55 years – the premenopausal group – cardiovascular disease risk is actually increasing. Over the past 10 years the mortality rate for cardiovascular disease has declined for men and has generally declined for women except for this young population,” said Janet Wei, MD, FACC, a cardiologist at the Barbra Streisand Women’s Heart Center and a faculty member of the Cedars-Sinai Heart Institute.

Men who have survived prostate cancer and women who have survived breast cancer are the largest percentage of cancer survivors, she said.

Cancer survivors have a greater than 2-fold risk of developing CVD compared to those without cancer, she said. “This is actually highest in the leukemia as well as breast cancer survivors.”

Cancer survivors with existing cardiovascular disease have an 11-fold increase risk of death compared to survivors without existing cardiovascular disease, Wei said.

“Breast cancer survivors have an almost 2-fold increased risk cardiovascular death than women without breast cancer,” she said. “Is this related to the cancer itself? We don’t think so, but it is related primarily to the presence of radiation history as well as chemotherapy history.”

The increased risk of CVD is evident 7 years after breast cancer diagnosis.

So what do you do when you have a patient who is in your office who has already started chemotherapy, Wei asked the audience.

“Unfortunately, we have no guidelines at all about what to do. There is still a tremendous gap in knowledge in terms of when to start potentially preventative cardiovascular medications,” she said.

Wei shared with the audience a list of medications that have shown in small clinical trials or retrospective cohort studies to potentially decrease the likelihood of left ventricular dysfunction: beta-blockers (carvedilol, nebivolol); ACE-Inhibitors (enalapril); angiotensin receptors blockers (valsartan, telmisartan); statins (atorvastatin); and dexrazoxane, which is a EDTA derivative.

“With these types of potential preventative agents, it is important to know what to do when you are monitoring a patient” in the beginning, middle and at the end of therapy, she said

Wei recommended to the audience a published consensus statement on the management of risk in cancer survivors for cardiovascular disease. In 2016, Hamo and colleagues in Circulation Heart Failure an article entitled “Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions.” Wei called the paper a “good, easy algorithm to put in your office.”

Finally, Wei reminded the audience that the ACC/AHA ASCVD calculator does not take into account a patient’s oncologic medical history and said there is more research to be conducted in this area. – by Joan-Marie Stiglich

Disclosures: Wei reports no financial disclosures.

Reference:

Wei J. Cardiometabolic risk in the cancer survivor. Presented at: Cardiometabolic Risk Summit Fall Conference; Oct. 14-16, 2016; Las Vegas.

https://www.ncbi.nlm.nih.gov/pubmed/26839395