Common genetic predisposition for heart failure and cancer
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Tobias J. Pfeffer · Stefan Pietzsch · Denise Hilfiker-Kleiner Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
© The Author(s) 2020
Common genetic predisposition for heart failure and cancer Background Cardiovascular diseases and cancer represent the most frequent causes for mortality and morbidity in industrialized countries [1]. Both diseases share common risk factors such as lifestyle and age and many patients are affected by both disease types. Nevertheless, for decades, in clinical routine cardiovascular diseases and cancer have been viewed separately and interdisciplinary treatment concepts were rarely considered. Likewise, intensive basic and clinical research has been performed in both fields and, although cancer and cardiovascular pathologies share many pathways, interdisciplinary cross-talk between researchers in the cancer and cardiovascular field was scarce. However, with the development of highly effective antitumor therapies, the prognosis and long-term survival of cancer patients improved, leading to an increased incidence of cardiovascular problems in these patients [2]. Furthermore, the cardiotoxic side effects of anticancer treatments such as irradiation and anticancer drugs, alone or in combination, became evident and have increasingly moved into the focus of the cardiovascular discipline [3]. Moreover, recent studies discovered interesting genetic interactions between the two disease entities, for example, heart failure was shown to promote transition of pretumor stages and tumor growth [4]. In addition, cancer predisposition syndrome mutations (CPS) are more frequent in patients with peripartum cardiomyopathy (PPCM) compared
The authors T.J. Pfeffer and S. Pietzsch contributed equally to the manuscript.
with age-matched women in the normal population [5]. Based on these connections between cancer and heart failure, interdisciplinary teams with specialized oncocardiology services emerged and oncocardiology became a new clinical and research field [6]. In the present review, we summarize current knowledge on the pathomechanistic connections between cancer and cardiovascular diseases with a specific focus on the role of genetics and the multihit hypothesis connecting both disease types.
Common risk factors Cancer and cardiovascular diseases display a multifactorial pathogenesis and many aspects of their pathogenesis are shared among the two entities. While some risk factors seem to be cancer specific, i.e., cancer-causing viral infections [7] or specific for cardiomyopathies (high blood pressure, cardiomyopathy-causing gene variants), many other risk factors are common for both disease types (e.g., smoking, metabolic syndrome, irradiation, age, air pollution, and environmental toxins). However, besides the long list of well-described common risk factors, recent studies showed that cardiovascular diseases and cancer also directly influence each other. In this regard, it is a well-known fact that many anticancer drugs, e.g., anthracyclines (such as epirubicin [8], daunorubi
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