Madrid, 23 July, 2024.- Cardiovascular diseases (CVD) are, along with secondary malignancies, the leading cause of death for cancer survivors and their treatment poses a huge challenge.2 Cardiotoxicity (CTX) is defined as the set of cardiovascular diseases resulting from onco-hematological treatments, and can affect any structural component of the cardiovascular system. These treatments could triple the risk of cardiovascular events in the medium and long term1.
In this context, the figure of the cardio-onco-hematologist has become fundamental to detect and manage the consequences of CTX and address cardio protective strategies to mitigate the damage and avoid the suspension of cancer therapy. “Long-term follow-up is often required because CTX can appear years later, as seen in thoracic radiotherapy,” warns Dr. Reddy Guerra, cardiologist at the MD Anderson Cancer Center Madrid – Hospiten Cardiology Department.
Cardio-onco-hematology is an emerging discipline that focuses on a clinical spectrum of cardiovascular problems that can arise during, subsequent to and sometimes long after cancer treatment. It is a specialty in which the care of patients with pre-existing cardiovascular disease (CVD) and those who develop CTX is provided by a multidisciplinary team composed of cardiologists, oncologists, hematologists, psychologists, specialist nurses and pharmacists, with the support of Primary Care physicians.
“As cardiologists, what we try to do is not stop the cancer treatment, but rather the opposite; in fact we accompany the patient at all times so that they, together with their oncologist and hematologist can complete their treatment while we simply monitor them. It is important for patients not to feel afraid”, explains Dr. Guerra.
Cardiovascular diseases arising from onco-hematological treatments
Although the classic definition of CTX focused on left ventricular (LV) systolic dysfunction, current scientific literature now defines it as a direct cardiac injury to any of the components of the cardiovascular system. This injury could cause cardiomyopathy and heart failure, myocarditis, pericarditis vascular toxicities, arrhythmias, coronary artery disease, premature valve disorders, hypertension and thromboembolism.
Essentially the three distinct clinical scenarios involve acute CTX, diagnosed while receiving cancer treatment; subacute CTX, which develops during the first 12 months after completing cardiotoxic treatments; and, in the longer term, cardiovascular complications from previous oncological treatments that appear after the first year.
How to reduce the risk of cardiotoxicity
“The cardio-onco-hematological team at MD Anderson Madrid – Hospiten conducts a detailed analysis before starting treatment to ensure that the patient will receive the best possible cancer treatment, while minimizing any risk to the heart and circulation,” explains Dr. Guerra. Close monitoring will take place during and after treatment, and continue as long as necessary to detect any side effects to the heart as promptly as possible.
The cardiologist reiterates the importance of maintaining a healthy lifestyle with regular physical exercise and a balanced diet to control cardiovascular risk factors. Likewise, maintaining LDL (“bad”) cholesterol levels <100 mg/dl is essential to reduce possible problems. ”In the case of patients with high cardiovascular risk, the objective will be to maintain LDL below 70 mg/dl, achieve glycated hemoglobin levels <7%, maintain a blood pressure below 140/90 mmHg and, of course, completely abstain from smoking,” says the expert.
“There has been a paradigm shift in cancer as a chronic disease as it has become clear that some cancers have sequelae even when they are considered cured. Pre-treatment cardiovascular evaluation, CTX detection and treatment, as well as long-term patient surveillance, are key functions of the cardiologist,” concludes Dr. Reddy Guerra.
References:
1. Cardio-Onco-Hematology in clinical practice. Consensus document and recommendations.
2. K. Miller, r.l. Siegel, C.C. Lin, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin., 66 (2016), pp. 271-289.