Therapy Insight: Management of CV Disease in Patients With Cancer

Summary and Introduction

Summary

Cardiac disease in patients with cancer or caused by cancer therapy is a clinical problem of emerging importance. Optimum management of cardiovascular disease can mean that patients with cancer can successfully receive therapies to treat their malignancy and can reduce morbidity and mortality due to cardiovascular disease in cancer survivors. The presence of cancer and cancer-related morbidities substantially complicates the management of cardiovascular disease in cancer patients. In this Review, we discuss management strategies for cardiovascular disease in patients with cancer, focusing on the prevention and treatment of congestive heart failure and myocardial infarction.

Introduction

The advent of modern cancer therapy has considerably improved the outcome of patients with cancer. Some forms of cancer that were routinely fatal even a few years ago are now thought of as chronic diseases that undergo cycles of remission, exacerbation and treatment. Thus, survivorship has emerged as a central issue in the management of patients with cancer. Indeed, many cancer survivors now actually have a higher risk of cardiovascular disease than of cancer recurrence.^[1,2] Preventing cardiovascular disease in patients with cancer and cardiac complications of cancer therapy might have dual benefits, allowing cancer patients to be treated more effectively with potentially life-saving cancer therapies, and preventing long-term cardiovascular morbidity and mortality in these individuals long after cancer therapy is complete.

There are a number of pathologic conditions -- such as heart failure, ischemia, thromboembolism, conduction abnormalities, and hypotension -- that have been reported to be associated with cancer therapy.^[3] The development of cardiovascular disease in patients with cancer presents a unique challenge for the clinician, for a number of reasons. First, the mechanisms by which chemotherapy treatments cause a particular cardiovascular disease might differ from the usual pathogenesis of the disorder, and thus extrapolating treatment guidelines for cardiac disease in patients who do not have cancer might not always be appropriate. Second, the presence of cancer often limits the treatment options that would normally be applied to patients with similar cardiovascular disease without cancer. In this Review, we focus on the management of two specific cardiovascular conditions seen in patients with cancer and those who have received cancer therapy: heart failure; and myocardial ischemia and infarction; both of which might lead to considerable morbidity and mortality in patients with cancer.

Cite this: Therapy Insight: Management of Cardiovascular Disease in Patients With Cancer and Cardiac Complications of Cancer Therapy - Medscape - Nov 01, 2008.

Sidebar: Key Points

In addition to alkylating agents and anthracyclines, some receptor tyrosine kinase inhibitors are potentially cardiotoxic
Patients with cancer who are treated with potentially cardiotoxic chemotherapy regimens represent a high-risk group for the development of heart failure, and should be treated in accordance with the new American Heart Association guidelines for the treatment of the stage A heart failure patient
Angiotensin-converting-enzyme inhibitors, beta blockers, and aldosterone antagonists have all been shown to improve morbidity and mortality related to heart failure in patients with cancer
Radiation-induced coronary artery disease is common and often presents many years after therapy; severe coronary artery disease induced by radiation therapy can be present in patients despite a paucity of symptoms
Aspirin therapy considerably reduces mortality in patients with myocardial infarction, including patients with cancer who have substantial thrombocytopenia
Interventional cardiologists should avoid the use of drug-eluting stents in patients with cancer

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