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Cancer Warriors losing battle to heart disease?

Your cancer treatment may be over, but does it continue to cause side effects to your body? Chemotherapy and radiation have revolutionized the survival rates among cancer patients, but so is the development of cardiovascular diseases (CVD) in cancer survivors. The scientific session 2021 program committee organized an educational session on cardio-oncology, which included talks by experts on heart health after cancer treatment, feedback link between heart and cancer, racial disparities, and new clinical imaging technology. The session was moderated by Dr. Susan Gilchrist from Houston, TX, Dr. Daniel Addison from Columbus, OH, and Dr. Mary Branch from Oak Ridge, NC. However, my favorite part was a short talk by Ms. Kikkan Randall, the first American cross-country skier to win Olympic gold along with her teammate. The session walked through the science journey and a patient journey and provided us perspective on a healthy heart from both expert’s and patient’s point of view.

Cardiovascular diseases are the leading non-cancerous cause of death among cancer survivors. Cardiac dysfunction, atherosclerosis, arrhythmia, and valvular diseases are major complications observed among cancer survivors. The first speaker in the cardio-oncology session was Dr. Saro Armenian from the City of Hope Comprehensive Cancer Center. He started by discussing the nature of the problem using the “Multiple-Hit” hypothesis, where he discussed how the margin of safety declines following cancer diagnosis and treatment. He further addressed the effect of tumor and cancer therapies on cardiac output, pulmonary function, muscle integrity, and oxygen-carrying capacity, all events ultimately causing cardiovascular aging among patients. He further walks us through how clonal hematopoiesis (a condition where we accumulate somatic mutation in the blood) can be the underlying cause of cardiovascular aging and drive CVD development among cancer patients. You can further read about clonal hematopoiesis and premature aging in one of his publications:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192097/

After a fantastic talk on premature cardiovascular aging in cancer patients, Dr. Clyde Yancy provided an exciting perspective on racial disparities. Adverse differences in numerous cancer burdens exist among specific population groups in the United States. For example, African American men are 111% more like to develop prostate cancer, whereas American Indian/Alaska Natives are twice as likely to develop liver and bile duct cancer. Similarly, racial, and ethnic health care disparities are present in cardio-oncology due to structural racism, higher prevalence of CVD risk factors, and reduced access to specialty care. A multidisciplinary approach involving stakeholders, health care policymakers, clinicians, scientists, and patients is required to resolve these disparities. Lastly, Dr. Clyde Yancy highlighted the importance of diverse population-based study and, in addition to genetic factors, phenotyping the social determinants of CV health. Read one of his recent publications about how poverty can increase the risk of heart problems:

https://pubmed.ncbi.nlm.nih.gov/34240286/

The third talk was from Dr. Rudolf A. de Boer from University Medical Center Groningen about reverse cardio-oncology. When I think about cardio-oncology, I always think about how cancer patients end up developing heart problems. However, he explained how the reverse could be true. He shared preclinical findings on how heart failure promotes tumor growth. Both CVD and cancer share several risk factors. Further, angiogenesis and inflammation under CVD conditions can increase the risk of tumor development. To learn more about cardio-oncology, refer to his recent review: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.119.013754

There were additional highlights on crosstalk on clinical imaging by Dr. Ana Barac from MedStar Heart. She listed the importance of cardiac imaging, echocardiography, and cardiac MRI.

Lastly, Olypoam Kikkan Randall, a cancer survivor, shared how she stayed committed to the 10-minute rule to keep her active despite adversity. Exercise training has been shown to confer beneficial effects in cancer patients at CVD risk. Here is an interesting article documenting a scientific statement from AHA for cancer survivors to manage cardiovascular outcomes. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000679

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