Acquired and modifiable cardiovascular risk factors in patients treated for cancer
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Acquired and modifiable cardiovascular risk factors in patients treated for cancer Gary S. Beasley1,2 · Jeffrey A. Towbin1,2 Accepted: 2 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cardiac mortality is the leading cause of death secondary to malignancy in survivors of cancer. The field of cardio-oncology is dedicated to identifying and, if possible, modifying risk factors that contribute to significant cardiac morbidity and mortality. Many risk factors for the development of cancer-related cardiotoxicity overlap with risk factors in cardiovascular disease such as hypertension, obesity, dyslipidemia, and diabetes among others. These risk factors are usually modifiable while others such as genetics, type of malignancy, and need for chemotherapy are less modifiable. This article summarizes acquired and modifiable risk factors in both pediatric and adult patients treated for cancer. Keywords Cardio-oncology · Chemotherapy related cardiotoxicity · Cardiovascular disease · Cancer
Highlights • Cancer and cardiovascular (CV) disease share many com-
mon risk factors, some of which are modifiable.
• Patients with CV disease are at an increased risk of devel-
oping cancer and the reciprocal is also true that patients with cancer are at an increased risk of developing CV disease. This might be related to several shared genetic and molecular pathways, many of which involve chronic inflammation. • The field of Cardio-Oncology continues to identify risk factors and treatment strategies for chemotherapy-related cardiotoxicity which also advances the field of CV disease.
* Gary S. Beasley [email protected] 1
Department of Pediatrics, Division of Cardiology Le Bonheur Children’s Hospital and The Heart Institute, University of Tennessee Health Science Center, College of Medicine, 49 N. Dunlap Street, 3rd Floor, Faculty Office Building, Memphis, TN 38105, USA
Cardio‑Hema‑Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
2
Introduction Advancements in the treatment of cancer have been some of the most successful medical breakthroughs in the past several decades with a current 5-year survival rate of greater than 63% in adults and 85% in pediatrics [1–4]. This accomplishment will result in an estimated 18 million cancer survivors, including more than 400,000 childhood cancer survivors, in the United States in the next 2 years [5–8]. Cardiovascular disease (CV) is the second leading cause of morbidity and mortality in patients with cancer, second only to the malignancy itself [5, 6, 9, 10]. Some studies suggest that up to 30% of patients with cancer will die from cardiovascular complications [11]. Survivors of childhood cancer are 8 to 10 times more likely to die from cardiovascular disease and are 15 times more likely to develop heart failure as compared with age-matched and sex-matched controls [6, 7, 10]. See Fig. 1 for the cumulative incidence of cardiac adverse events in childhood cancer survivors. This, along with factors such as acute cardiovascu
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