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 Chemotherapy can weaken the heart muscle, some newer targeted
medicines can increase the risk of heart failure, and radiation can
cause heart rhythm disorders and structural damage in the arteries
and heart valves, the AHA emphasizes in its scientific statement on
the link between breast cancer and heart disease.
Cardiovascular disease is the number one cause of death in women,
and this risk increases with age, noted Dr. Laxmi Mehta, lead author
of the statement and section director of preventive cardiology and
women’s cardiovascular health at the Ohio State University Medical
center in Columbus.
“So as breast cancer survivors are living longer, their risks of
cardiovascular disease increase,” Mehta said by email.
Breast cancer survivors, especially women over age 65, are more
likely to die from cardiovascular disease than tumors, the AHA
statement stresses.
This doesn’t mean women should skip lifesaving cancer therapies, but
it does mean they should be aware of the cardiac side effects and be
monitored for cardiovascular disease during treatment and
afterwards, Mehta added.
“Any patient who is going to undergo breast cancer treatment,
whether they have heart disease at the beginning or not, should be
aware of the potential effects on their heart,” Mehta advised.
Several cancer treatments have long been linked to an increased risk
of heart problems in the future.
For example, anthracyclines, such as doxorubicin, are a type of
chemotherapy that has been used since the 1970s and can cause
irreversible damage to the left ventricle, the heart’s main pumping
chamber.
And taxanes, such as paclitaxel, have been linked to irregular heart
rates and rhythm disorders.
Trastuzumab and pertuzumab, targeted therapies for an aggressive
type of malignancy known as HER-2 positive breast cancer, can also
damage the left ventricle but this damage may be reversible after
treatment stops. Women who develop heart failure while taking these
drugs may be able to alter treatment to help prevent worsening or
permanent cardiac damage.
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Another chemotherapy - doxorubicin - can damage heart cells, but the
risk of heart failure may be reduced when the medicine is
administered slowly, rather than all at once. Women taking this
medicine may also reduce their risk of heart failure by pairing it
with another drug, dexrazoxane.
Radiation can damage arteries and cause blockages, but newer
techniques can deliver lower and more targeted doses of radiation
that are less toxic to the heart than standard regimens a generation
ago.
Heart disease and breast cancer share many of the same risk factors,
including obesity, inactivity, smoking, and poor eating habits,
according to the AHA statement published in Circulation. Lifestyle
changes designed to avoid these risk factors may help women minimize
their risk of cancer and heart problems.
“Women have a higher risk for heart disease if they go untreated for
existing cardiovascular risk factors or develop risk factors such as
obesity or low fitness during breast cancer treatment,” said Dr.
Susan Gilchrist, a cardiology professor at the University of Texas
MD Anderson Cancer Center in Houston.
Even when women don’t have any risk factors for heart disease when
they’re diagnosed with breast cancer, they should still adopt a
heart-healthy lifestyle to lower the chances of developing heart
problems associated with cancer treatments, the AHA recommends.
“The key message is to be proactive and focus on prevention,”
Gilchrist, who wasn’t involved in the AHA statement, said by email.
“Stay active during treatment, avoid smoking and weight gain, get to
goal with blood pressure and cholesterol, and do appropriate
cardiovascular screening as determined by your oncologist.”
SOURCE: http://bit.ly/2C3JVjM Circulation, online February 1, 2018.
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