Cancer Treatments Carry Serious Cardiovascular Risks

The American Heart Association (AHA) recently issued a scientific statement published in Circulation regarding the high risk of cardiovascular disease faced by many patients with breast cancer. Patients may benefit from a treatment strategy that is informed by weighing the cardiovascular risks compared with the benefits of the drugs.

The new statement provides an overview of the known risk factors for heart disease and breast cancer, potential heart damage from breast cancer treatments, and suggestions for mitigating damage.

The AHA noted that breast cancer survivors, typically those 65 years and older, are more likely to die from heart disease than breast cancer, which highlights the significance of managing cardiovascular risk factors pre- and post-treatment.

“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 of the treatments on their heart,” said Laxmi Mehta, MD, chair of the writing group for the statement. “This should not deter or scare patients from undergoing breast cancer treatment but should allow them to make informed decisions with their doctor on the best cancer treatment for them.”

During treatment, patients should monitor their overall health, especially their hearts, according to the AHA.

The authors said that HER2-targeted breast cancer treatments can cause heart failure. This adverse event can be temporary, and patients may require treatment cessation or additional therapies to improve heart function; however, some patients may experience permanent heart failure, according to the statement.

Recent small trials suggest that changing the administration of common chemotherapies may be able to mitigate heart disease risks. For example, when doxorubicin is administered slowly, patients may be at a lower risk of heart failure, the AHA reported.

Additionally, dexrazoxane was approved by the FDA to reduce the risk of cell damage among patients with metastatic breast cancer, but further large-scale studies are needed to confirm the impact of the drug.

Radiation can also have adverse effects on the heart’s arteries and spark the development of coronary artery disease and blockages, according to the statement. The AHA said that treatment with anthracyclines has been observed to cause abnormal heart rhythms that can be life-threatening in some cases.

The authors also said that antimetabolites can cause heart arteries to spasm, which can result in chest pain and heart attacks.

Both breast cancer and heart disease share risk factors, including older age, poor diet, family history, lack of exercise, and smoking. The authors suggest that lifestyle modifications could reduce the risk of these conditions, according to the statement.

The AHA urges health care providers to monitor patients’ cardiovascular health before, during, and after treatment.

“Fortunately, with the advances in breast cancer treatment, there has been a growing number of survivors. However, during and after the treatment of breast cancer, having optimal control of heart disease risk factors is important, because older breast cancer survivors are more likely to die of heart disease than breast cancer,” Dr Mehta said.