Thanks to advances in early detection and treatment, people with cancer are living far longer than in past decades. But cancer survivors should be aware that cancer and its treatments can compromise cardiovascular health, according to a recent study from the CDC.
Researchers studied more than 840,000 adults, including about 69,000 cancer survivors, to see how much cancer “ages” the heart. They found that adult men treated for cancer had hearts that appeared to be 8.5 years older than their actual age, while the hearts of women who survived cancer appeared to be 6.5 years older.
“The findings support the idea that perhaps the standard methods we use to predict heart disease are not designed for people who’ve been treated for cancer,” says Dr. Tomas Neilan, director of the cardio-oncology program at Harvard-affiliated Massachusetts General Hospital. For example, doctors often use an online calculator (such as the one at www.health.harvard.edu/ascvd) to project a person’s chance of having a heart attack or stroke over the next 10 years. The resulting score is used to guide decisions about whether certain people should take a statin to lower their risk. (Most people who already have had a heart attack or stroke or who have diabetes should take a statin; the calculator is intended for those without those conditions.) Meanwhile, other research is exploring the role of statins during and after cancer treatment (see “Statins and cancer”).
|Statins and cancerObservational studies suggest that women already taking statins during chemotherapy for breast cancer were less likely to develop heart failure than those not taking statins. Clinical trials are now underway to further test this observation. Also, a 2015 review article involving a total of nearly one million people with cancer (including colon, prostate, and breast cancer, among others) found that statin use either before or after a cancer diagnosis was linked to improved survival.|
Cancer as a risk enhancer
Currently, guidelines suggest that people with risk scores above 5% who also have one or more risk-enhancing factors should consider taking a statin. These risk-enhancing factors include a family history of early heart disease and conditions such as chronic kidney disease and rheumatoid arthritis — but not cancer. “We may need to think about cancer as a risk-enhancing factor, given what we know about how the disease and its treatments affect the heart,” says Dr. Neilan. When he and colleagues tested the risk calculator in people who had undergone treatment for head and neck cancer, the incidence of heart disease in these patients was three times higher than the risk calculator predicted, he says.
Cancer and heart disease share some underlying risks, including tobacco use and obesity. However, the results from that study and the one from the CDC took into account traditional heart disease risk factors, including smoking, body mass index, blood pressure, and diabetes, says Dr. Neilan. Tobacco use is a well-known risk for head and neck cancers, which affect the mouth, nose, and throat. But in recent decades, these cancers have been increasingly linked to human papillomavirus (HPV) infections, he notes.
In recent years, cancer treatment has shifted away from traditional cytotoxic (cell-killing) chemotherapy to therapies that target biological factors that underlie the cancer. Some work by blocking signals that enable cancer cells to grow, while others trigger the immune system to destroy cancer cells. The first immune-based therapy was approved about a decade ago. But today, there are more than 50 potential uses for these therapies, which could be used to treat about 36% of all cancers, says Dr. Neilan.
Most are so-called immune checkpoint inhibitors, which frequently cause mild side effects such as a rash or diarrhea. But sometimes these therapies trigger an autoimmune reaction that attacks various organs, including the heart. This inflammation of the heart (myocarditis) occurs in only 0.5% to 1% of cases but has a very high fatality rate. Other possible complications include heart attacks and heart rhythm disorders.
Early recognition and interventions can address these heart issues. “The reality is, I wouldn’t have a job if the oncologists weren’t doing such a fantastic job keeping people alive,” says Dr. Neilan.
The bottom line: If you’ve been treated for cancer, stay vigilant for any new heart-related symptoms during and after treatment and report them right away to your primary care physician or oncologist. The most common symptoms include shortness of breath, weakness, fatigue, and a rapid, irregular heartbeat.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
“Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.” – Philippians 4:8
“Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.” – Mark 11:24
“Anxiety weighs down the heart, but a kind word cheers it up.” – Proverbs 12:25
“Who of you by worrying can add a single hour to your life?” – Luke 12:25
“For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.” – Jeremiah 29:11
“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11
“A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22
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