There have been considerable advancements in cancer therapy in recent years. However, adverse effects often defeat the benefits, especially on the cardiovascular system. The effects of chemotherapeutic agents on the c...There have been considerable advancements in cancer therapy in recent years. However, adverse effects often defeat the benefits, especially on the cardiovascular system. The effects of chemotherapeutic agents on the cardiovascular system can be directly on the heart by altering the coagulability state or by altering the hemodynamic system. Some drugs like Sunitinib and Bevacizumab show Heart Failure which is chemotherapy-induced. Other agents are notorious for showing QT prolongation like Vandetanib. Similarly, other agents with demonstrated cardiotoxicity would be molecular-targeted drugs (Trastuzumab and Pertuzumab) and cytostatic agents (Anthracycline antibiotics, Cyclophosphamide and 5-FU). These effects may present early or late, during or after the treatment. Most of the research has focused on the management and monitoring of patients for cancer who are under treatment, for example new biomarkers in the field of proteomics have been discovered for the diagnosis, treatment, and monitoring of patients. While the upgrades have been successful in reducing mortalities, with the advent of better treatment outcomes, the several adverse effects on the cardiac system cannot be dismissed. For instance, damage to the cardiomyocytes is most frequently associated with the treatment. The damage can further expedite LV failure, valvular dysfunction, conduction abnormalities, etc. Hence, a better management plan for patients with cancer would be one that not only caters to primary cancer treatment but also incorporates ventricular systolic function evaluation using echocardiography, electrocardiography, and cardiac biomarkers for the well-being of patients. Our article focuses on introducing an ideal cardio-oncology team along with the components required for setting up the team. This needs a multidisciplinary approach to reduce patients’ cardiovascular morbidity, during and after the interventions. With the growing population of patients undergoing cancer therapy, the risk of developing cardiovascular problems has further escalated. Hence, development of a cardio-oncology multidisciplinary team would be of utmost importance to not only improve patient care but also to improve quality of life.展开更多
New uses of cardiovascular drugs with proven experience are emerging,including for treating cancer.Quinazoline is a compound made up of two fused six member simple aromatic rings,benzene and pyrimidine rings,with seve...New uses of cardiovascular drugs with proven experience are emerging,including for treating cancer.Quinazoline is a compound made up of two fused six member simple aromatic rings,benzene and pyrimidine rings,with several biological effects.Cardiologists first used quinazoline-based α1-adrenoceptor antagonists prazosin,doxazosin,and terazosin; currently available data support their use as safe,well tolerated,and effective add-on therapy in uncontrolled hypertension with additional favourable metabolic effects.Recent findings highlight the anticancer effects of quinazoline-based α1-adrenoceptor antagonists,indicating that they may have a significant role in uncontrolled hypertensive cancer patients without signs of ischemia.展开更多
Therapy development for cancer and cardiovascular disease(CVD)to prolong lifespan makes the relationship between these two conditions more complex.Drug interactions in cardiology and oncology are associated with metab...Therapy development for cancer and cardiovascular disease(CVD)to prolong lifespan makes the relationship between these two conditions more complex.Drug interactions in cardiology and oncology are associated with metabolism and drug transportation.Advances in biomarkers and imaging provide novel methods for detecting cardiotoxicity,including cardiac injury and inflammation.The new concept of CVD-related cancer risk is leading to a new direction of progression termed“reverse cardio-oncology.”展开更多
To the Editor:Cancer and cardiovascular disease constitute the two major causes of death worldwide. Whereas the incidence of cancer increases among adults up to 74 years of age, above this age the cardiovascular disea...To the Editor:Cancer and cardiovascular disease constitute the two major causes of death worldwide. Whereas the incidence of cancer increases among adults up to 74 years of age, above this age the cardiovascular disease surpasses cancer as the primary cause of mortality.[1] Currently, chemotherapy, radiation therapy, and surgery are the main modalities for the treatment of cancer. However, chemotherapy can induce cardiovascular worsening, manifesting as acute and chronic symptomatology. Therefore, the verv interesting report published in Chinese Medical Journal[2] concerning a 60-year-old male patient suffering from coronary artery disease and squamous cell carcinoma of the left lung who developed an ST segment elevation myocardial infarction following treatment with afatinib (tyrosine kinase inhibitor) and gemcitabine (antimetabolite pyrimidine antagonist) and cisplatin (platinum based DNA replication inhibitor) and the subsequent discussion raise several important considerations on cardiac toxicity, cardiac hypersensitivity and the Kounis-hypersensitivity acute coronary syndrome.展开更多
Vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor (VEGFR-TKI), an oral molecular targeted drug, reportedly causes serious adverse cardiovascular events such as hypertension and left ventricu...Vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor (VEGFR-TKI), an oral molecular targeted drug, reportedly causes serious adverse cardiovascular events such as hypertension and left ventricular failure. The association between VEGFR-TKI-induced hypertension and heart failure with preserved left ventricular ejection fraction (LVEF) (HFpEF) has been previously studied. Therefore, we investigated the relationship between hypertension onset and associated cardiac diastolic dysfunction due to VEGFR-TKI use. Patients who used VEGFR-TKIs (target drugs: sunitinib, axitinib, sorafenib, pazopanib, and cabozantinib) at the Department of Urology, Hokkaido Cancer Center were recruited between May 2009 and October 2021 and were divided into two groups based on whether their blood pressure was elevated during VEGFR-TKI use. The markers of left ventricular diastolic function (E/A, Dct (ms), mean E/e, septal e') and left ventricular systolic function (LVEF, LVDd, and LVDs) were evaluated. LVEF and mean E/e in the elevated blood pressure group (n = 41) showed significant changes before and after treatment. LVEF values (contractile function markers) in the TKI-HT (+) group significantly decreased from 70.7% ± 6.8% before treatment to 68.3% ± 7.8% after treatment (p = 0.03). Conversely, no significant difference was observed for any ventricular systolic function marker in the TKI-HT (−) group. E/e (diastolic function marker) in the TKI-HT (+) group significantly decreased from 11.9% ± 3.6% before treatment to 10.3% ± 3.0% after treatment (p = 0.02). However, no change was observed in any ventricular diastolic function marker in the TKI-HT (−) group. The results of this study suggest that cardiac function may be affected in patients using VEGFR-TKI. Furthermore, appropriate antihypertensive treatment and early monitoring with regular echocardiography, even in asymptomatic patients, may help prevent VEGFR-TKI-induced deterioration of systolic and diastolic function.展开更多
BACKGROUND Cardiovascular side effects occur frequently during anti-cancer treatment, and there is a growing concern that they may lead to premature morbidity and death. CASE SUMMARY A 32-year-old woman was diagnosed ...BACKGROUND Cardiovascular side effects occur frequently during anti-cancer treatment, and there is a growing concern that they may lead to premature morbidity and death. CASE SUMMARY A 32-year-old woman was diagnosed with breast cancer. After comprehensive treatment with neoadjuvant chemotherapy, surgery, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and endocrine therapy, her breast cancer was cured. However, heart failure associated with anti-cancer treatment presented, most probably related to chemotherapy containing anthracycline. After active treatment, her cardiac function returned to normal. Unfortunately, follow-up visits revealed a second primary malignancy, lymphoma. After multiple courses of chemotherapy combined with targeted therapy, her lymphoma acquired complete remission and no cardiotoxicity was observed again. Heart failure related to breast treatment may be reversible. CONCLUSION Using alternatives to anthracycline in patients with lymphoma who are at risk of cardiac failure may preserve cardiac function.展开更多
Although under-recognized,cancer survivors continue to be at an increased risk of death from cardiovascular complications post-remission or cure.This increased burden of cardiovascular disease results from the interpl...Although under-recognized,cancer survivors continue to be at an increased risk of death from cardiovascular complications post-remission or cure.This increased burden of cardiovascular disease results from the interplay of various factors.Adequate cardiovascular risk assessment and timely intervention through a multi-disciplinary approach in these patients plays a pivotal role in the prevention of cardiovascular morbidity and mortality.We discuss the shortcomings of using current risk prediction scores in cancer survivors and provide some insights into cardiovascular risk management relevant for primary care physicians,oncologists,and cardiologists alike.展开更多
Objective:To systematically evaluate the therapeutic effect of TCM on cardiotoxicity induced by anthracycline chemotherapy to provide clinical guidance.Methods:China hownet database(CNKI),Chinese biomedical literature...Objective:To systematically evaluate the therapeutic effect of TCM on cardiotoxicity induced by anthracycline chemotherapy to provide clinical guidance.Methods:China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library were searched from inception to 1st,December,2020.Relevant combined TCM and Western medicine on cardiotoxicity randomized controlled trials(RCTs)were collected.The risk of bias in included RCTs were evaluated according to the Cochrane Handbook.The required indicators were extracted and included in RevMan5.4 analysis.Results:A total of 2844 patients were included in 37 RCTs.The results of meta-analysis showed that compared with the control group,TCM treatment group could alleviate the effect of anthracycline on ventricular ejection function,reduce the effect of anthracycline chemotherapy drugs in lowering left ventricular ejection fraction(WMD=6.44,95%CI 0.38 to 12.50,P=0.04),reduce the effect of anthracycline chemotherapy in increasing left ventricular end diastolic diameter(WMD=-0.59,95%CI-0.74 to-0.44,P<0.00001),reduce the effect of anthracycline chemotherapy drugs in increasing left ventricular end systolic diameter(WMD=-0.47,95%CI-0.60 to-0.34,P<0.00001),and reduce the effect of anthracyclines on troponin I(WMD=-0.19,95%CI-0.23 to-0.16,P<0.00001),troponin T(WMD=-0.02,95%CI-0.03 to-0.01,P<0.00001)and brain natriuretic peptide(WMD=-32.21,95%CI-58.21 to-6.22,P=0.02).Conclusion:The existing evidence can prove that TCM has a protective effect on cardiotoxicity caused by anthracycline chemotherapy,maintaining left ventricular ejection fraction and ventricular diameter,controlling the level of myocardial injury markers,and alleviating cardiac injury.展开更多
Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and sign...Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and significantly reducing the patient's quality of life and survival.In this study,an animal model of doxorubicin-induced cardiomyopathy was used to investigate the pathogenesis of doxorubicin-induced myocardial injury.This study also investigated a possible treatment strategy for alleviating myocardial injury through resveratrol therapy in vitro.Methods Adult male C57BL/6J mice were randomly divided into a control group and a doxorubicin group.Body weight,echocardiography,surface electrocardiogram,and myocardial histomorphology were measured.The mechanisms of doxorubicin cardiotoxicity in H9c2 cell lines were explored by comparing three groups(phosphate-buffered saline,doxorubicin,and doxorubicin with resveratrol).Results Compared to the control group,the doxorubicin group showed a lower body weight and higher systolic arterial pressure,associated with reduced left ventricular ejection fraction and left ventricular fractional shortening,prolonged PR interval,and QT interval.These abnormalities were associated with vacuolation and increased disorder in the mitochondria of cardiomyocytes,increased protein expression levels of α-smooth muscle actin and caspase 3,and reduced protein expression levels of Mitofusin2(MFN2)and Sirtuin1(SIRT1).Compared to the doxorubicin group,doxorubicin+resveratrol treatment reduced caspase 3 and manganese superoxide dismutase,and increased MFN2 and SIRT1 expression levels.Conclusion Doxorubicin toxicity leads to abnormal mitochondrial morphology and dysfunction in cardiomyocytes and induces apoptosis by interfering with mitochondrial fusion.Resveratrol ameliorates doxorubicin-induced cardiotoxicity by activating SIRT1/MFN2 to improve mitochondria function.展开更多
Owing to early diagnosis and rapid development of treatments for cancers,the five-year survival rate of all cancer types has markedly improved worldwide.Over time,however,there has been an increase in the number of ca...Owing to early diagnosis and rapid development of treatments for cancers,the five-year survival rate of all cancer types has markedly improved worldwide.Over time,however,there has been an increase in the number of cancer patients who develop coronary artery disease(CAD)due to different causes.First,many risk factors are shared between cancer and CAD.Second,inflammation and oxidative stress are common underlying pathogeneses in both disorders.Lastly,cancer therapy can result in endothelial injury,coronary artery spasm,and coagulation,thereby increasing the risk of CAD.As more cancer patients are being diagnosed with CAD,specialized cardiac care should be established to minimize the cardiovascular mortality of cancer survivors.展开更多
文摘There have been considerable advancements in cancer therapy in recent years. However, adverse effects often defeat the benefits, especially on the cardiovascular system. The effects of chemotherapeutic agents on the cardiovascular system can be directly on the heart by altering the coagulability state or by altering the hemodynamic system. Some drugs like Sunitinib and Bevacizumab show Heart Failure which is chemotherapy-induced. Other agents are notorious for showing QT prolongation like Vandetanib. Similarly, other agents with demonstrated cardiotoxicity would be molecular-targeted drugs (Trastuzumab and Pertuzumab) and cytostatic agents (Anthracycline antibiotics, Cyclophosphamide and 5-FU). These effects may present early or late, during or after the treatment. Most of the research has focused on the management and monitoring of patients for cancer who are under treatment, for example new biomarkers in the field of proteomics have been discovered for the diagnosis, treatment, and monitoring of patients. While the upgrades have been successful in reducing mortalities, with the advent of better treatment outcomes, the several adverse effects on the cardiac system cannot be dismissed. For instance, damage to the cardiomyocytes is most frequently associated with the treatment. The damage can further expedite LV failure, valvular dysfunction, conduction abnormalities, etc. Hence, a better management plan for patients with cancer would be one that not only caters to primary cancer treatment but also incorporates ventricular systolic function evaluation using echocardiography, electrocardiography, and cardiac biomarkers for the well-being of patients. Our article focuses on introducing an ideal cardio-oncology team along with the components required for setting up the team. This needs a multidisciplinary approach to reduce patients’ cardiovascular morbidity, during and after the interventions. With the growing population of patients undergoing cancer therapy, the risk of developing cardiovascular problems has further escalated. Hence, development of a cardio-oncology multidisciplinary team would be of utmost importance to not only improve patient care but also to improve quality of life.
文摘New uses of cardiovascular drugs with proven experience are emerging,including for treating cancer.Quinazoline is a compound made up of two fused six member simple aromatic rings,benzene and pyrimidine rings,with several biological effects.Cardiologists first used quinazoline-based α1-adrenoceptor antagonists prazosin,doxazosin,and terazosin; currently available data support their use as safe,well tolerated,and effective add-on therapy in uncontrolled hypertension with additional favourable metabolic effects.Recent findings highlight the anticancer effects of quinazoline-based α1-adrenoceptor antagonists,indicating that they may have a significant role in uncontrolled hypertensive cancer patients without signs of ischemia.
文摘Therapy development for cancer and cardiovascular disease(CVD)to prolong lifespan makes the relationship between these two conditions more complex.Drug interactions in cardiology and oncology are associated with metabolism and drug transportation.Advances in biomarkers and imaging provide novel methods for detecting cardiotoxicity,including cardiac injury and inflammation.The new concept of CVD-related cancer risk is leading to a new direction of progression termed“reverse cardio-oncology.”
文摘To the Editor:Cancer and cardiovascular disease constitute the two major causes of death worldwide. Whereas the incidence of cancer increases among adults up to 74 years of age, above this age the cardiovascular disease surpasses cancer as the primary cause of mortality.[1] Currently, chemotherapy, radiation therapy, and surgery are the main modalities for the treatment of cancer. However, chemotherapy can induce cardiovascular worsening, manifesting as acute and chronic symptomatology. Therefore, the verv interesting report published in Chinese Medical Journal[2] concerning a 60-year-old male patient suffering from coronary artery disease and squamous cell carcinoma of the left lung who developed an ST segment elevation myocardial infarction following treatment with afatinib (tyrosine kinase inhibitor) and gemcitabine (antimetabolite pyrimidine antagonist) and cisplatin (platinum based DNA replication inhibitor) and the subsequent discussion raise several important considerations on cardiac toxicity, cardiac hypersensitivity and the Kounis-hypersensitivity acute coronary syndrome.
文摘Vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor (VEGFR-TKI), an oral molecular targeted drug, reportedly causes serious adverse cardiovascular events such as hypertension and left ventricular failure. The association between VEGFR-TKI-induced hypertension and heart failure with preserved left ventricular ejection fraction (LVEF) (HFpEF) has been previously studied. Therefore, we investigated the relationship between hypertension onset and associated cardiac diastolic dysfunction due to VEGFR-TKI use. Patients who used VEGFR-TKIs (target drugs: sunitinib, axitinib, sorafenib, pazopanib, and cabozantinib) at the Department of Urology, Hokkaido Cancer Center were recruited between May 2009 and October 2021 and were divided into two groups based on whether their blood pressure was elevated during VEGFR-TKI use. The markers of left ventricular diastolic function (E/A, Dct (ms), mean E/e, septal e') and left ventricular systolic function (LVEF, LVDd, and LVDs) were evaluated. LVEF and mean E/e in the elevated blood pressure group (n = 41) showed significant changes before and after treatment. LVEF values (contractile function markers) in the TKI-HT (+) group significantly decreased from 70.7% ± 6.8% before treatment to 68.3% ± 7.8% after treatment (p = 0.03). Conversely, no significant difference was observed for any ventricular systolic function marker in the TKI-HT (−) group. E/e (diastolic function marker) in the TKI-HT (+) group significantly decreased from 11.9% ± 3.6% before treatment to 10.3% ± 3.0% after treatment (p = 0.02). However, no change was observed in any ventricular diastolic function marker in the TKI-HT (−) group. The results of this study suggest that cardiac function may be affected in patients using VEGFR-TKI. Furthermore, appropriate antihypertensive treatment and early monitoring with regular echocardiography, even in asymptomatic patients, may help prevent VEGFR-TKI-induced deterioration of systolic and diastolic function.
文摘BACKGROUND Cardiovascular side effects occur frequently during anti-cancer treatment, and there is a growing concern that they may lead to premature morbidity and death. CASE SUMMARY A 32-year-old woman was diagnosed with breast cancer. After comprehensive treatment with neoadjuvant chemotherapy, surgery, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and endocrine therapy, her breast cancer was cured. However, heart failure associated with anti-cancer treatment presented, most probably related to chemotherapy containing anthracycline. After active treatment, her cardiac function returned to normal. Unfortunately, follow-up visits revealed a second primary malignancy, lymphoma. After multiple courses of chemotherapy combined with targeted therapy, her lymphoma acquired complete remission and no cardiotoxicity was observed again. Heart failure related to breast treatment may be reversible. CONCLUSION Using alternatives to anthracycline in patients with lymphoma who are at risk of cardiac failure may preserve cardiac function.
文摘Although under-recognized,cancer survivors continue to be at an increased risk of death from cardiovascular complications post-remission or cure.This increased burden of cardiovascular disease results from the interplay of various factors.Adequate cardiovascular risk assessment and timely intervention through a multi-disciplinary approach in these patients plays a pivotal role in the prevention of cardiovascular morbidity and mortality.We discuss the shortcomings of using current risk prediction scores in cancer survivors and provide some insights into cardiovascular risk management relevant for primary care physicians,oncologists,and cardiologists alike.
基金National Key Research and Development Program(No.2018YFC1704901)。
文摘Objective:To systematically evaluate the therapeutic effect of TCM on cardiotoxicity induced by anthracycline chemotherapy to provide clinical guidance.Methods:China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library were searched from inception to 1st,December,2020.Relevant combined TCM and Western medicine on cardiotoxicity randomized controlled trials(RCTs)were collected.The risk of bias in included RCTs were evaluated according to the Cochrane Handbook.The required indicators were extracted and included in RevMan5.4 analysis.Results:A total of 2844 patients were included in 37 RCTs.The results of meta-analysis showed that compared with the control group,TCM treatment group could alleviate the effect of anthracycline on ventricular ejection function,reduce the effect of anthracycline chemotherapy drugs in lowering left ventricular ejection fraction(WMD=6.44,95%CI 0.38 to 12.50,P=0.04),reduce the effect of anthracycline chemotherapy in increasing left ventricular end diastolic diameter(WMD=-0.59,95%CI-0.74 to-0.44,P<0.00001),reduce the effect of anthracycline chemotherapy drugs in increasing left ventricular end systolic diameter(WMD=-0.47,95%CI-0.60 to-0.34,P<0.00001),and reduce the effect of anthracyclines on troponin I(WMD=-0.19,95%CI-0.23 to-0.16,P<0.00001),troponin T(WMD=-0.02,95%CI-0.03 to-0.01,P<0.00001)and brain natriuretic peptide(WMD=-32.21,95%CI-58.21 to-6.22,P=0.02).Conclusion:The existing evidence can prove that TCM has a protective effect on cardiotoxicity caused by anthracycline chemotherapy,maintaining left ventricular ejection fraction and ventricular diameter,controlling the level of myocardial injury markers,and alleviating cardiac injury.
基金Tianjin Key Medical Discipline(Specialty)Construction Project,Grant/Award N umber:TJY XZDXK-029ANational Natural Science Foundation of China,Grant/Award Numbers:81970270,82170327Tianjin Postgr aduate Scientific Research Innovation Projec,G rant/Award Number:2021YJSB278。
文摘Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and significantly reducing the patient's quality of life and survival.In this study,an animal model of doxorubicin-induced cardiomyopathy was used to investigate the pathogenesis of doxorubicin-induced myocardial injury.This study also investigated a possible treatment strategy for alleviating myocardial injury through resveratrol therapy in vitro.Methods Adult male C57BL/6J mice were randomly divided into a control group and a doxorubicin group.Body weight,echocardiography,surface electrocardiogram,and myocardial histomorphology were measured.The mechanisms of doxorubicin cardiotoxicity in H9c2 cell lines were explored by comparing three groups(phosphate-buffered saline,doxorubicin,and doxorubicin with resveratrol).Results Compared to the control group,the doxorubicin group showed a lower body weight and higher systolic arterial pressure,associated with reduced left ventricular ejection fraction and left ventricular fractional shortening,prolonged PR interval,and QT interval.These abnormalities were associated with vacuolation and increased disorder in the mitochondria of cardiomyocytes,increased protein expression levels of α-smooth muscle actin and caspase 3,and reduced protein expression levels of Mitofusin2(MFN2)and Sirtuin1(SIRT1).Compared to the doxorubicin group,doxorubicin+resveratrol treatment reduced caspase 3 and manganese superoxide dismutase,and increased MFN2 and SIRT1 expression levels.Conclusion Doxorubicin toxicity leads to abnormal mitochondrial morphology and dysfunction in cardiomyocytes and induces apoptosis by interfering with mitochondrial fusion.Resveratrol ameliorates doxorubicin-induced cardiotoxicity by activating SIRT1/MFN2 to improve mitochondria function.
基金This work was supported by a grant from the National Natural Science Foundation of China(No.81830012).
文摘Owing to early diagnosis and rapid development of treatments for cancers,the five-year survival rate of all cancer types has markedly improved worldwide.Over time,however,there has been an increase in the number of cancer patients who develop coronary artery disease(CAD)due to different causes.First,many risk factors are shared between cancer and CAD.Second,inflammation and oxidative stress are common underlying pathogeneses in both disorders.Lastly,cancer therapy can result in endothelial injury,coronary artery spasm,and coagulation,thereby increasing the risk of CAD.As more cancer patients are being diagnosed with CAD,specialized cardiac care should be established to minimize the cardiovascular mortality of cancer survivors.
