Cancer and cardiovascular disease are the two most common non communicable diseases which cause the highest global mortality. In recent years, the growing volume of elderly population and improved overall survival has led to co-existence of cardiovascular disease and cancer in a large group of patients. Patterns of geographic distribution of heart disease mortality and cancer mortalities in the united states have shown similarities which is believed to be a result of common risk factors in the pathogenesis of both disease groups such as smoking, hyperlipidemia and obesity. Inflammation has been recognized as a shared process among the mentioned risk factors.
On one hand, there is increased risk of cardiovascular disease or presence of its risk factors in patients who are candidates for oncologic treatments, and on the other hand, the overall improvement in treatment outcomes of cancer patients has led to increased prominence of the cardiovascular side effects of the mentioned treatments. Moreover, cardiovascular events have been recognized as a major cause of mortality among cancer survivors, which in some cancer types might actually exceed the mortality rate related to re-occurrence of the baseline malignancy.
There is a wide range of adverse cardiovascular effects resulting from cancer treatments. Cardiotoxicity of the Anthracyclines may be the most studied cardiovascular effect of a cancer treatment which results in systolic dysfunction and heart failure in a dose dependent manner. However, with the increased survival of the patients and the diversity in treatments, multiple mechanisms have been recognized which affect the entire cardiovascular system. Coronary disease, arrhythmia, thromboembolic events, valvular disease, hypertension and pericardial involvement have all been demonstrated as side effects in patients receiving treatment for cancer. Although there are no official guidelines, there exist recommendations regarding monitoring and management of complications in each of the mentioned category.
Addressing the challenges associated with caring for these patients has led to the development of a new branch of medicine called cardio-oncology. The main purpose of this specialty is to consider both aspects of cardiology and oncology in a patient, and create a bridge between the two fields in order to make the best decisions regarding prevention, monitoring, and treatment of the diseases.
Azin Alizadehasl, MD, FACC, FASE