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Ilkhanoff L, Atwater B, Barac A. Atrial Fibrillation Amplifies Heart Failure Risk in Anthracycline Treated Cancer Patients: Stacking Risk Factors in the Vulnerable. Am J Cardiol 2024; 218:121-122. [PMID: 38438005 DOI: 10.1016/j.amjcard.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Leonard Ilkhanoff
- Inova Schar Heart and Vascular, Division of Cardiology, Section of Electrophysiology, Falls Church, Virginia.
| | - Brett Atwater
- Inova Schar Heart and Vascular, Division of Cardiology, Section of Electrophysiology, Falls Church, Virginia
| | - Ana Barac
- Inova Schar Cancer, Division of Cardiology, Falls Church, Virginia
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Agarwal S, Qamar U, Fujiwara Y, Guha A, Naqash AR, Yang EH, Addison D, Barac A, Asad ZUA. The Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes in Patients With Cancer: A Systematic Review and Meta-Analysis. Am J Cardiol 2024; 216:87-90. [PMID: 38373679 DOI: 10.1016/j.amjcard.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Usama Qamar
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yu Fujiwara
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Abdul Rafeh Naqash
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Daniel Addison
- Cardio-Oncology Program, The Ohio State University, Columbus, Ohio
| | - Ana Barac
- Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, Virginia
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Chlebowski RT, Aragaki AK, Pan K, Nelson RA, Barac A, Manson JE, Stefanick ML, Ikramuddin FS, Johnson KC, Krok-Schoen JL, Laddu D, Pichardo MS, Snetselaar LG, LeBoff MS, Michael Y. Dietary Intervention Favorably Influences Physical Functioning: The Women's Health Initiative Randomized Dietary Modification Trial. J Acad Nutr Diet 2024:S2212-2672(24)00091-1. [PMID: 38395355 DOI: 10.1016/j.jand.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND In the Women's Health Initiative Dietary Modification randomized trial, the dietary intervention reduced breast cancer mortality by 21% (P = .02) and increased physical activity as well. OBJECTIVE Therefore, the aim was to examine whether or not these lifestyle changes attenuated age-related physical functioning decline. DESIGN In a randomized trial, the influence of 8 years of a low-fat dietary pattern intervention was examined through 20 years of cumulative follow-up. PARTICIPANTS AND SETTING From 1993 to 1998, 48,835 postmenopausal women, ages 50 to 79 years with no prior breast cancer and negative baseline mammogram were randomized at 40 US clinical centers to dietary intervention or usual diet comparison groups (40 out of 60). The intervention significantly reduced fat intake and increased vegetable, fruit, and grain intake. MAIN OUTCOME MEASURES In post hoc analyses, physical functioning, assessed using the RAND 36-Item Short Form Health Survey, evaluated quality or limitations of 10 hierarchical physical activities. Longitudinal physical functioning, reported against a disability threshold (when assistance in daily activities is required) was the primary study outcome. STATISTICAL ANALYSES PERFORMED Semiparametric linear mixed effect models were used to contrast physical functioning trajectories by randomization groups. RESULTS Physical functioning score, assessed 495,317 times with 11.0 (median) assessments per participant, was significantly higher in the intervention vs comparison groups through 12 years of cumulative follow-up (P = .001), representing a reduction in age-related functional decline. The intervention effect subsequently attenuated and did not delay time to the disability threshold. Among women in the dietary intervention vs comparison groups, aged 50 to 59 years, who were physically inactive at entry, a persistent, statistically significant, favorable influence on physical functioning with associated delay in crossing the disability threshold by approximately a year was seen (P value for interaction = .007). CONCLUSIONS In the Women's Health Initiative Dietary Modification randomized trial, a dietary intervention that significantly reduced breast cancer mortality also significantly reduced age-related functional decline through 12 years, which was attenuated with longer follow-up.
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Affiliation(s)
| | | | - Kathy Pan
- Kaiser Permanente Southern California, Downey, California
| | - Rebecca A Nelson
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Ana Barac
- Inova Heart and Vascular Institute, Georgetown University, Fairfax, Virginia
| | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Marcia L Stefanick
- Stanford Preventive Medicine Research Center, Stanford School of Medicine, Stanford, California
| | - Farha S Ikramuddin
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jessica L Krok-Schoen
- Health Sciences School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Deepika Laddu
- Department of Physical Therapy College of Applied Health Sciences, The University of Illinois at Chicago, Chicago, Illinois
| | - Margaret S Pichardo
- Department of Surgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | | | - Meryl S LeBoff
- Endocrinology, Diabetes and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yvonne Michael
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania
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Murtagh G, deFilippi C, Zhao Q, Barac A. Circulating biomarkers in the diagnosis and prognosis of immune checkpoint inhibitor-related myocarditis: time for a risk-based approach. Front Cardiovasc Med 2024; 11:1350585. [PMID: 38410245 PMCID: PMC10894940 DOI: 10.3389/fcvm.2024.1350585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that block immune checkpoints and therefore activate immune cells, allowing them to recognize and attack cancer cells. ICIs have revolutionized oncology practice, but their use has been complicated by immune-related adverse events (irAEs). Of cardiovascular (CV) irAEs, ICI-related myocarditis has received significant attention due to high mortality rates, ranging from 25% to 50%, despite its overall low incidence. Establishing the early diagnosis of ICI-myocarditis is important for early initiation of steroids and consideration of hospitalization in patients who are at risk for hemodynamic compromise and need high acuity care in a tertiary setting. In this review, we summarize the diagnostic and prognostic tools for ICI-myocarditis, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, with emphasis on circulating biomarkers. Cardiac troponins (cTns) are an essential component of the diagnosis of ICI-myocarditis, and we provide a summary of the recent studies that utilized different assays (cTnI vs. cTnT) and outcomes (diagnosis vs. prognosis including major adverse cardiac outcomes). With the exponential increase in ICI use across different oncology indications, there is a major need to include biomarkers in risk stratification to guide diagnosis and treatment. Our review proposes a framework for future multisite registries, including cTn evaluation at baseline and at the time of irAE suspicion, with development of central biobanking to allow head-to-head evaluation and clinical validation of different biomarker assays in ICI-myocarditis. This approach, with the inclusion of CV biomarkers into clinical and pragmatic oncology trials, holds promise to improve the early recognition and management of ICI-myocarditis and CV irAEs, thus leading to better outcomes.
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Affiliation(s)
- Gillian Murtagh
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
| | | | - Qiong Zhao
- Inova Schar Heart and Vascular, Falls Church, VA, United States
| | - Ana Barac
- Inova Schar Heart and Vascular, Falls Church, VA, United States
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Anthony KM, Collins JM, Love SAM, Stewart JD, Buchheit SF, Gondalia R, Schwartz GG, Huang DY, Meliker JR, Zhang Z, Barac A, Desai P, Hayden KM, Honigberg MC, Jaiswal S, Natarajan P, Bick AG, Kooperberg C, Manson JE, Reiner AP, Whitsel EA. Radon Exposure, Clonal Hematopoiesis, and Stroke Susceptibility in the Women's Health Initiative. Neurology 2024; 102:e208055. [PMID: 38170948 PMCID: PMC10870742 DOI: 10.1212/wnl.0000000000208055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Studies suggest that clonal hematopoiesis of indeterminate potential (CHIP) may increase risk of hematologic malignancy and cardiovascular disease, including stroke. However, few studies have investigated plausible environmental risk factors for CHIP such as radon, despite the climate-related increases in and documented infrequency of testing for this common indoor air pollutant.The purpose of this study was to estimate the risk of CHIP related to radon, an established environmental mutagen. METHODS We linked geocoded addresses of 10,799 Women's Health Initiative Trans-Omics for Precision Medicine (WHI TOPMed) participants to US Environmental Protection Agency-predicted, county-level, indoor average screening radon concentrations, categorized as follows: Zone 1 (>4 pCi/L), Zone 2 (2-4 pCi/L), and Zone 3 (<2 pCi/L). We defined CHIP as the presence of one or more leukemogenic driver mutations with variant allele frequency >0.02. We identified prevalent and incident ischemic and hemorrhagic strokes; subtyped ischemic stroke using Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria; and then estimated radon-related risk of CHIP as an odds ratio (OR) and 95% CI using multivariable-adjusted, design-weighted logistic regression stratified by age, race/ethnicity, smoking status, and stroke type/subtype. RESULTS The percentages of participants with CHIP in Zones 1, 2, and 3 were 9.0%, 8.4%, and 7.7%, respectively (ptrend = 0.06). Among participants with ischemic stroke, Zones 2 and 1 were associated with higher estimated risks of CHIP relative to Zone 3: 1.39 (1.15-1.68) and 1.46 (1.15-1.87), but not among participants with hemorrhagic stroke: 0.98 (0.68-1.40) and 1.03 (0.70-1.52), or without stroke: 1.04 (0.74-1.46) and 0.95 (0.63-1.42), respectively (pinteraction = 0.03). Corresponding estimates were particularly high among TOAST-subtyped cardioembolism: 1.78 (1.30-2.47) and 1.88 (1.31-2.72), or other ischemic etiologies: 1.37 (1.06-1.78) and 1.50 (1.11-2.04), but not small vessel occlusion: 1.05 (0.74-1.49) and 1.00 (0.68-1.47), respectively (pinteraction = 0.10). Observed patterns of association among strata were insensitive to attrition weighting, ancestry adjustment, prevalent stroke exclusion, separate analysis of DNMT3A driver mutations, and substitution with 3 alternative estimates of radon exposure. DISCUSSION The robust elevation of radon-related risk of CHIP among postmenopausal women who develop incident cardioembolic stroke is consistent with a potential role of somatic genomic mutation in this societally burdensome form of cerebrovascular disease, although the mechanism has yet to be confirmed.
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Affiliation(s)
- Kurtis M Anthony
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Jason M Collins
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Shelly-Ann M Love
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - James D Stewart
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Sophie F Buchheit
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Rahul Gondalia
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Gary G Schwartz
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - David Y Huang
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Jaymie R Meliker
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Zhenzhen Zhang
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Ana Barac
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Pinkal Desai
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Kathleen M Hayden
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Michael C Honigberg
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Siddhartha Jaiswal
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Pradeep Natarajan
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Alexander G Bick
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Charles Kooperberg
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - JoAnn E Manson
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Alexander P Reiner
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Eric A Whitsel
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
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Kattapuram N, Shadman S, Morgan EE, Benton C, Awojoodu S, Kim DY, Ramos J, Barac A, Bandettini WP, Kellman P, Weissman G, Carlsson M. Timing of Regadenoson-induced Peak Hyperemia and the Effects on Coronary Flow Reserve. medRxiv 2024:2024.01.15.23300449. [PMID: 38410488 PMCID: PMC10896412 DOI: 10.1101/2024.01.15.23300449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Regadenoson is used to induce hyperemia in cardiac imaging, facilitating diagnosis of ischemia and assessment of coronary flow reserve (CFR). While the regadenoson package insert recommends administration of radionuclide tracer 10-20 seconds after injection, peak hyperemia has been observed at approximately 100 seconds after injection in healthy volunteers undergoing cardiovascular magnetic resonance imaging (CMR). It is unclear when peak hyperemia occurs in a patient population. Objectives The goal of this study was to determine time to peak hyperemia after regadenoson injection in healthy volunteers and patients, and whether the recommended image timing in the package insert underestimates CFR. Methods Healthy volunteers (n=15) and patients (n=25) underwent stress CMR, including phase-contrast imaging of the coronary sinus at rest and multiple timepoints after 0.4 mg regadenoson injection. Coronary sinus flow (ml/min) was divided by resting values to yield CFR. Smoothed, time-resolved curves for CFR were generated with pointwise 95% confidence intervals. Results CFR between 60 and 120 seconds was significantly higher than CFR at 30 seconds after regadenoson injection (p < 0.05) as shown by non-overlapping 95% confidence intervals for both healthy volunteers (30 s, [2.8, 3.4]; 60 s, [3.8, 4.4]; 90 s, [4.1, 4.7]; 120 s, [3.6, 4.3]) and patients (30 s, [2.1, 2.5]; 60 s, [2.6, 3.1]; 90 s, [2.7, 3.2]; 120 s, [2.5, 3.1]). Conclusion Imaging at 90 seconds following regadenoson injection is the optimal approach to capture peak hyperemia. Imaging at 30 seconds, which is more aligned with the package insert recommendation, would yield an underestimate of CFR and confound assessment of microvascular dysfunction.
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Affiliation(s)
- Nathan Kattapuram
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Shahrad Shadman
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Eric E. Morgan
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Charles Benton
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Stacian Awojoodu
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Dong-Yun Kim
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Joao Ramos
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Ana Barac
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
- Inova Schar Heart and Vascular, Falls Church, VA, USA
| | - W. Patricia Bandettini
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Peter Kellman
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Gaby Weissman
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marcus Carlsson
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
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7
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Avula V, Sharma G, Kosiborod MN, Vaduganathan M, Neilan TG, Lopez T, Dent S, Baldassarre L, Scherrer-Crosbie M, Barac A, Liu J, Deswal A, Khadke S, Yang EH, Ky B, Lenihan D, Nohria A, Dani SS, Ganatra S. SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Cancer Therapy-Related Cardiac Dysfunction. JACC Heart Fail 2024; 12:67-78. [PMID: 37897456 DOI: 10.1016/j.jchf.2023.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Certain antineoplastic therapies are associated with an increased risk of cardiomyopathy and heart failure (HF). Sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF. OBJECTIVES This study aims to examine the efficacy of SGLT2 inhibitors in patients with cancer therapy-related cardiac dysfunction (CTRCD) or HF. METHODS The authors conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients aged ≥18 years with a history of type 2 diabetes mellitus, cancer, and exposure to potentially cardiotoxic antineoplastic therapies, with a subsequent diagnosis of cardiomyopathy or HF between January 1, 2013, and April 30, 2020, were identified. Patients with ischemic heart disease were excluded. Patients receiving guideline-directed medical therapy were divided into 2 groups based on SGLT2 inhibitor use. After propensity score matching, odds ratios (ORs) and Cox proportional HRs were used to compare outcomes over a 2-year follow-up period. RESULTS The study cohort included 1,280 patients with CTRCD/HF (n = 640 per group; mean age: 67.6 years; 41.6% female; 68% White). Patients on SGLT2 inhibitors in addition to conventional guideline-directed medical therapy had a lower risk of acute HF exacerbation (OR: 0.483 [95% CI: 0.36-0.65]; P < 0.001) and all-cause mortality (OR: 0.296 [95% CI: 0.22-0.40]; P = 0.001). All-cause hospitalizations or emergency department visits (OR: 0.479; 95% CI: 0.383-0.599; P < 0.001), atrial fibrillation/flutter (OR: 0.397 [95% CI: 0.213-0.737]; P = 0.003), acute kidney injury (OR: 0.486 [95% CI: 0.382-0.619]; P < 0.001), and need for renal replacement therapy (OR: 0.398 [95% CI: 0.189-0.839]; P = 0.012) were also less frequent in patients on SGLT2 inhibitors. CONCLUSIONS SGLT2 inhibitor use is associated with improved outcomes in patients with CTRCD/HF.
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Affiliation(s)
- Vennela Avula
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri, Kansas City, Missouri, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Teresa Lopez
- Department of Cardiology, La Paz University Hospital, Madrid, Spain
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Lauren Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ana Barac
- Cardio-Oncology Program, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jennifer Liu
- Cardio-Oncology Program, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sumanth Khadke
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Eric H Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Lenihan
- International Cardio-Oncology Society, Tampa, Florida, USA; St. Francis Healthcare, Cape Girardeau, Missouri, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sourbha S Dani
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
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8
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López-Fernández T, Farmakis D, Ameri P, Asteggiano R, de Azambuja E, Aznar M, Barac A, Bayes-Genis A, Bax JJ, Bergler-Klein J, Boriani G, Celutkiene J, Coats A, Cohen-Solal A, Córdoba R, Cosyns B, Filippatos G, Fox K, Gulati G, Inciardi RM, Lee G, Mamas MA, Novo G, Plummer C, Psyrri A, Rakisheva A, Suter T, Tini G, Tocchetti CG, Toutouzas K, Wilhelm M, Metra M, Lyon AR, Rosano GMC. European Society of Cardiology Core Curriculum for cardio-oncology. Eur J Heart Fail 2023. [PMID: 38059343 DOI: 10.1002/ejhf.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
Cardio-oncology is a rapidly growing field of cardiovascular (CV) medicine that has resulted from the continuously increasing clinical demand for specialized CV evaluation, prevention and management of patients suffering or surviving from malignant diseases. Dealing with CV disease in patients with cancer requires special knowledge beyond that included in the general core curriculum for cardiology. Therefore, the European Society of Cardiology (ESC) has developed a special core curriculum for cardio-oncology, a consensus document that defines the level of experience and knowledge required for cardiologists in this particular field. It is structured into 8 chapters, including (i) principles of cancer biology and therapy; (ii) forms and definitions of cancer therapy-related cardiovascular toxicity (CTR-CVT); (iii) risk stratification, prevention and monitoring protocols for CTR-CVT; (iv) diagnosis and management of CV disease in patients with cancer; (v) long-term survivorship programmes and cardio-oncology rehabilitation; (vi) multidisciplinary team management of special populations; (vii) organization of cardio-oncology services; (viii) research in cardio-oncology. The core curriculum aims at promoting standardization and harmonization of training and evaluation in cardio-oncology, while it further provides the ground for an ESC certification programme designed to recognize the competencies of certified specialists.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Riccardo Asteggiano
- Faculty of Medicine, Insubria University, Varese, Italy
- LARC (Laboratorio Analisi e Ricerca Clinica), Turin, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, VA, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris Cite University, INSERM U-942, Paris, France
| | - Raúl Córdoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute, Instituto de Investigación Sanitaria-Fundación Jiménez-Díaz (IIS-FJD), Madrid, Spain
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kevin Fox
- Imperial College Healthcare NHS Trust; NHS Orkney, Orkney, UK
| | - Geeta Gulati
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Riccardo M Inciardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Chris Plummer
- Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - Amina Rakisheva
- City Cardiolocal Center, Almaty, Kazakhstan
- Qonaev city hospital, Almaty, Kazakhstan
| | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giacomo Tini
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | | | - Matthias Wilhelm
- Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Guys and St. Thomas NHS Foundation Trust, London, UK
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9
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Love SAM, Collins JM, Anthony KM, Buchheit SF, Butler EN, Bey GS, Gondalia R, Hayden KM, Zannas AS, Bick AG, Manson JE, Desai PM, Natarajan P, Bhattacharya R, Jaiswal S, Barac A, Reiner A, Kooperberg C, Stewart JD, Whitsel EA. Individual and Neighborhood-level Socioeconomic Status and Somatic Mutations Associated With Increased Risk of Cardiovascular Disease and Mortality: A Cross-Sectional Analysis in the Women's Health Initiative. Womens Health Issues 2023:S1049-3867(23)00186-X. [PMID: 38061917 DOI: 10.1016/j.whi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Clonal hematopoiesis of indeterminate potential (CHIP), the expansion of leukemogenic mutations in white blood cells, has been associated with increased risk of atherosclerotic cardiovascular diseases, cancer, and mortality. OBJECTIVE We examined the relationship between individual- and neighborhood-level socioeconomic status (SES) and CHIP and evaluated effect modification by interpersonal and intrapersonal resources. METHODS The study population included 10,799 postmenopausal women from the Women's Health Initiative without hematologic malignancy or antineoplastic medication use. Individual- and neighborhood (Census tract)-level SES were assessed across several domains including education, income, and occupation, and a neighborhood-level SES summary z-score, which captures multiple dimensions of SES, was generated. Interpersonal and intrapersonal resources were self-reports. CHIP was ascertained based on a prespecified list of leukemogenic driver mutations. Weighted logistic regression models adjusted for covariates were used to estimate risk of CHIP as an odds ratio (OR) and 95% confidence interval (95% CI). RESULTS The interval-scale neighborhood-level SES summary z-score was associated with a 3% increased risk of CHIP: OR (95% CI) = 1.03 (1.00-1.05), p = .038. Optimism significantly modified that estimate, such that among women with low/medium and high levels of optimism, the corresponding ORs (95% CIs) were 1.03 (1.02-1.04) and 0.95 (0.94-0.96), pInteraction < .001. CONCLUSIONS Our findings suggest that reduced risk of somatic mutation may represent a biological pathway by which optimism protects contextually advantaged but at-risk women against age-related chronic disease and highlight potential benefits of long-term, positive psychological interventions.
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Affiliation(s)
- Shelly-Ann M Love
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Jason M Collins
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Kurtis M Anthony
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Sophie F Buchheit
- Division of Biology and Medicine, Brown University, Providence, Rhode Island
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Rahul Gondalia
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina; Injury Surveillance and Analytics, Real-World Analytics Solutions, IQVIA, Durham, North Carolina
| | - Kathleen M Hayden
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony S Zannas
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina; Department of Genetics, University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Institute for Trauma Recovery, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Medicine, Neuroscience Curriculum, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Pinkal M Desai
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, New York
| | - Pradeep Natarajan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Romit Bhattacharya
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Siddhartha Jaiswal
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Ana Barac
- Division of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, District of Columbia; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Alex Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - James D Stewart
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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10
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Agarwal S, Guha A, Krishan S, Naqash AR, Addison D, Yang EH, Barac A, Asad ZUA. Statins for Primary Prevention of Anthracycline Chemotherapy-Related Cardiac Dysfunction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Cardiol 2023; 206:63-66. [PMID: 37683579 DOI: 10.1016/j.amjcard.2023.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Abdul Rafeh Naqash
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Daniel Addison
- Cardio-Oncology Program, The Ohio State University, Columbus, Ohio
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Ana Barac
- Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, Virginia
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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11
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Addison D, Neilan TG, Barac A, Scherrer-Crosbie M, Okwuosa TM, Plana JC, Reding KW, Taqueti VR, Yang EH, Zaha VG. Cardiovascular Imaging in Contemporary Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1271-1286. [PMID: 37732422 DOI: 10.1161/cir.0000000000001174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Advances in cancer therapeutics have led to dramatic improvements in survival, now inclusive of nearly 20 million patients and rising. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Advances in cardiovascular imaging have solidified the critical role for robust methods for detecting, monitoring, and prognosticating cardiac risk among patients with cancer. However, decentralized evaluations have led to a lack of consensus on the optimal uses of imaging in contemporary cancer treatment (eg, immunotherapy, targeted, or biological therapy) settings. Similarly, available isolated preclinical and clinical studies have provided incomplete insights into the effectiveness of multiple modalities for cardiovascular imaging in cancer care. The aims of this scientific statement are to define the current state of evidence for cardiovascular imaging in the cancer treatment and survivorship settings and to propose novel methodological approaches to inform the optimal application of cardiovascular imaging in future clinical trials and registries. We also propose an evidence-based integrated approach to the use of cardiovascular imaging in routine clinical settings. This scientific statement summarizes and clarifies available evidence while providing guidance on the optimal uses of multimodality cardiovascular imaging in the era of emerging anticancer therapies.
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12
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deFilippi C, Barac A. Cardiac Troponins for Diagnosis and Prognostic Assessment of Immune Checkpoint Inhibitor Myocarditis and Myositis: The Emerging Importance of Peripheral Vision. Circulation 2023; 148:1135-1137. [PMID: 37812655 DOI: 10.1161/circulationaha.123.065988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
| | - Ana Barac
- Inova Schar Heart and Vascular, Falls Church, VA
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13
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Teske AJ, Moudgil R, López-Fernández T, Barac A, Brown SA, Deswal A, Neilan TG, Ganatra S, Abdel Qadir H, Menon V, Sverdlov AL, Cheng RK, Makhoul S, Ghosh AK, Szmit S, Zaha V, Addison D, Zhang L, Herrmann J, Chong JH, Agarwala V, Iakobishvili Z, Guerrero P, Yang EH, Leja M, Akhter N, Guha A, Okwuosa TM, Silva CC, Collier P, DeCara J, Bauer B, Lenneman CE, Sadler D. Global Cardio Oncology Registry (G-COR): Registry Design, Primary Objectives, and Future Perspectives of a Multicenter Global Initiative. Circ Cardiovasc Qual Outcomes 2023; 16:e009905. [PMID: 37702048 PMCID: PMC10824596 DOI: 10.1161/circoutcomes.123.009905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Global collaboration in cardio-oncology is needed to understand the prevalence of cancer therapy-related cardiovascular toxicity in different risk groups, practice settings, and geographic locations. There are limited data on the socioeconomic and racial/ethnic disparities that may impact access to care and outcomes. To address these gaps, we established the Global Cardio-Oncology Registry, a multinational, multicenter prospective registry. METHODS We assembled cardiologists and oncologists from academic and community settings to collaborate in the first Global Cardio-Oncology Registry. Subsequently, a survey for site resources, demographics, and intention to participate was conducted. We designed an online data platform to facilitate this global initiative. RESULTS A total of 119 sites responded to an online questionnaire on their practices and main goals of the registry: 49 US sites from 23 states and 70 international sites from 5 continents indicated a willingness to participate in the Global Cardio-Oncology Registry. Sites were more commonly led by cardiologists (85/119; 72%) and were more often university/teaching (81/119; 68%) than community based (38/119; 32%). The average number of cardio-oncology patients treated per month was 80 per site. The top 3 Global Cardio-Oncology Registry priorities in cardio-oncology care were breast cancer, hematologic malignancies, and patients treated with immune checkpoint inhibitors. Executive and scientific committees and specific committees were established. A pilot phase for breast cancer using Research Electronic Data Capture Cloud platform recently started patient enrollment. CONCLUSIONS We present the structure for a global collaboration. Information derived from the Global Cardio-Oncology Registry will help understand the risk factors impacting cancer therapy-related cardiovascular toxicity in different geographic locations and therefore contribute to reduce access gaps in cardio-oncology care. Risk calculators will be prospectively derived and validated.
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Affiliation(s)
- Arco J Teske
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands (A.J.T.)
| | - Rohit Moudgil
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | | | - Ana Barac
- Medstar Heart Institute, Georgetown University, WA, DC (A.B.)
| | | | | | - Tomas G Neilan
- Massachusetts General Hospital, Harvard Medical School, Boston (T.G.N.)
| | - Sarju Ganatra
- Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.G.)
| | | | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | - Aaron L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, Calvary Mater Newcastle, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, NSW, Australia (A.L.S.)
| | | | - Silvia Makhoul
- Hospital Juan A Fernández/Hospital Británico de Buenos Aires Buenos Aires, Argentina (S.M.)
| | - Arjun K Ghosh
- Barts Heart Centre, St Bartholomew's Hospital (A.K.G.), London, United Kingdom
- University College London Hospital (A.K.G.), London, United Kingdom
- Hatter Cardiovascular Institute (A.K.G.), London, United Kingdom
| | - Sebastian Szmit
- Centre of Postgraduate Medical Education, Warsaw, Poland (S.S.)
| | - Vlad Zaha
- UT Southwestern Medical Center, Dallas, TX (V.Z.)
| | | | - Lili Zhang
- Montefiore Medical Center/Albert Einstein College of Medicine, NY (L.Z.)
| | | | | | - Vivek Agarwala
- Narayana Superspeciality Hospital and Cancer Institute and RN Tagore Cancer Center, Kolkata, India (V.A.)
| | - Zaza Iakobishvili
- Department of Cardiology, Tel Aviv Jaffa District Clalit Health Services, Tel Aviv, Israel (Z.I.)
| | | | - Eric H Yang
- University of California Los Angeles (E.H.Y.)
| | - Monika Leja
- University of Michigan Medical Center, Ann Arbor (M.L.)
| | - Nausheen Akhter
- Northwestern University Feinberg School of Medicine, Chicago, IL (N.A.)
| | - Avirup Guha
- Cardio-Oncology Program, Department of Medicine, Georgia Cancer Center, Medical College of Georgia at Augusta University, GA (A.G.)
| | | | | | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | - Jeanne DeCara
- University of Chicago School of Medicine, IL (J.D.C.)
| | - Brenton Bauer
- COR Healthcare Associates/Torrance Memorial Medical Center, CA (B.B.)
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14
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Wilson RL, Christopher CN, Yang EH, Barac A, Adams SC, Scott JM, Dieli-Conwright CM. Incorporating Exercise Training into Cardio-Oncology Care: Current Evidence and Opportunities: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:553-569. [PMID: 37969654 PMCID: PMC10635898 DOI: 10.1016/j.jaccao.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Cancer treatment-induced cardiotoxicities are an ongoing concern throughout the cancer care continuum from treatment initiation to survivorship. Several "standard-of-care" primary, secondary, and tertiary prevention strategies are available to prevent the development or further progression of cancer treatment-induced cardiotoxicities and their risk factors. Despite exercise's established benefits on the cardiovascular system, it has not been widely adopted as a nonpharmacologic cardioprotective strategy within cardio-oncology care. In this state-of-the-art review, the authors discuss cancer treatment-induced cardiotoxicities, review the existing evidence supporting the role of exercise in preventing and managing these sequelae in at-risk and affected individuals living after cancer diagnoses, and propose considerations for implementing exercise-based services in cardio-oncology practice.
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Affiliation(s)
- Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric H. Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, Virginia, USA
| | - Scott C. Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Jessica M. Scott
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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15
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Agarwal S, Munir MB, Krishan S, Yang EH, Barac A, Asad ZUA. Outcomes and readmissions in patients with cancer undergoing catheter ablation for atrial fibrillation. Europace 2023; 25:euad263. [PMID: 37655932 PMCID: PMC10485182 DOI: 10.1093/europace/euad263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ana Barac
- Division of Cardio-Oncology, Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, VA, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA
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Hovsepyan G, Barac A, Brasky TM, Shadyab AH, Lehman A, McLaughlin EM, Saquib N, Iyengar NM, Wild RA, Caan BJ, Desai P, Beebe Dimmer J, Thomson CA, Simon MS. Pre-diagnosis lipid levels and mortality after obesity-related cancer diagnosis in the Women's Health Initiative cardiovascular disease biomarker cohort. Cancer Med 2023; 12:16626-16636. [PMID: 37381978 PMCID: PMC10469749 DOI: 10.1002/cam4.6266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Published studies have demonstrated inconclusive relationships between serum lipid levels and mortality after cancer. METHODS The primary objective was to evaluate the relationship between fasting lipid levels and mortality after cancer. Data were obtained on baseline lipids and outcomes after cancer from 1263 postmenopausal women diagnosed with 13 obesity-related cancers who were part of the Women's Health Initiative (WHI) lipid biomarkers cohort. Obesity-related cancers included incident invasive cancers of the breast, colorectum, endometrium, esophagus (adenocarcinoma), kidney, liver, gallbladder, pancreas, ovaries, small intestine, thyroid, stomach, as well as multiple myeloma. Baseline lipid measurements included high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, and non-HDL-cholesterol. Outcomes were all cause, cancer-specific, and CVD mortality. Multivariable Cox proportional hazards models were used to measure associations between lipid levels and mortality (all cause, cancer, and CVD) after a cancer diagnosis, with lipids analyzed as continuous variables. RESULTS Among women with obesity-related cancer, there were 707 deaths, of which 379 (54%) were due to cancer and 113 (16%) were due to CVD. Mean time from blood draw to cancer diagnosis was 5.1 years (range: 0.05-10 years). LDL-C values above the 95th percentile were associated with higher risk of all-cause mortality (p < 0.001), and cancer-specific mortality (p < 0.001), but not mortality due to CVD. Non-HDL-C values above the 65th percentile were associated with higher risk of all-cause mortality (p = 0.01) and mortality due to CVD (p = 0.003), but not cancer-specific mortality (p = 0.37). HDL-C values above the 95th percentile were associated with lower all-cause mortality (p = 0.002), and above the 65th percentile with lower cancer-specific mortality (p = 0.003), but no significant relationship with mortality due to CVD was observed. CONCLUSIONS The relationship between pre-diagnosis fasting lipid levels and mortality after cancer diagnosis is complex. These results suggest that improved lipid control through lifestyle and anti-lipid medications could have a meaningful impact on outcomes after cancer.
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Affiliation(s)
- Gayane Hovsepyan
- Wayne State University School of MedicineDetroitMichiganUSA
- Scripps Green Internal Medicine Residency ProgramLa JollaCaliforniaUSA
| | - Ana Barac
- Georgetown UniversityWashingtonDistrict of ColumbiaUSA
- Inova Heart and Vascular InstituteFalls ChurchVirginiaUSA
| | | | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Amy Lehman
- Center for BiostatisticsOhio State UniversityColumbusOhioUSA
| | | | - Nazmus Saquib
- College of MedicineSulaiman AlRajhi UniversityAl BukayriyahSaudi Arabia
| | | | - Robert A. Wild
- University of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Medical Program of Northern CaliforniaOaklandCaliforniaUSA
| | - Pinkal Desai
- Department of OncologyWeill Cornell Medical CenterNew YorkNew YorkUSA
| | - Jennifer Beebe Dimmer
- Wayne State University School of MedicineDetroitMichiganUSA
- Department of OncologyBarbara Ann Karmanos Cancer Institute at Wayne Sate UniversityDetroitMichiganUSA
| | - Cynthia A. Thomson
- Department of Health Promotion SciencesMel & Enid Zuckerman College of Public Health and Arizona Cancer CenterUniversity of ArizonaTucsonArizonaUSA
| | - Michael S. Simon
- Wayne State University School of MedicineDetroitMichiganUSA
- Department of OncologyBarbara Ann Karmanos Cancer Institute at Wayne Sate UniversityDetroitMichiganUSA
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17
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Peila R, Xue X, Qi Q, Dannenberg AJ, Allison MA, Johnson KC, LaMonte MJ, Wild RA, Haring B, Pan K, Tindle HA, Foraker R, Saquib N, Barac A, Rohan TE. Healthy Lifestyle Index and Risk of Cardiovascular Disease Among Postmenopausal Women With Normal Body Mass Index. J Am Heart Assoc 2023:e029111. [PMID: 37306150 DOI: 10.1161/jaha.122.029111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background A lifestyle comprising a healthy diet, light alcohol consumption, no smoking, and moderate or intense physical activity has been associated with reduced risk of cardiovascular disease (CVD). We examined the association of a healthy lifestyle index (HLI), derived from scores for each of these components plus waist circumference, with the risk of incident CVD and CVD subtypes in postmenopausal women with normal body mass index (18.5-<25.0 kg/m2). Methods and Results We studied 40 118 participants in the Women's Health Initiative, aged 50 to 79 years at enrollment, with a normal body mass index and no history of CVD. The HLI score was categorized into quintiles. We estimated multivariable adjusted hazard ratios (HR) and 95% CIs for the association of HLI with risk of CVD and CVD subtypes using Cox regression models. A total of 3821 cases of incident CVD were ascertained during a median follow-up of 20.1 years. Compared with the lowest quintile (unhealthiest lifestyle), higher HLI quintiles showed inverse associations with the risk of CVD (HRquintile-2=0.74 [95% CI, 0.67-0.81]; HRquintile-3=0.66 [95% CI, 0.60-0.72]; HRquintile-4=0.57 [95% CI, 0.51-0.63]; and HRquintile-5=0.48 [95% CI, 0.43-0.54], P-trend=<0.001). HLI was also inversely associated with risks of stroke, coronary heart disease, myocardial infarction, angina, and coronary revascularization. Subgroup analyses, stratified by age (≤63 years vs >63 years), body mass index (</≥ 22.0 kg/m2), and general health status (absence/presence of hypertension, diabetes, or lipid-lowering drug use) also showed inverse associations between HLI and risk of CVD. Conclusions Among postmenopausal women with a normal body mass index, adherence to a healthy lifestyle is associated with a reduced risk of clinical CVD and CVD subtypes, underscoring the cardiovascular benefits of maintaining a healthy lifestyle, even for women with a healthy weight.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | - Qibin Qi
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
| | | | - Matthew A Allison
- Family Medicine and Public Health University of California CA San Diego USA
| | - Karen C Johnson
- Department of Preventive Medicine The University of Tennessee TN Memphis USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health University of Buffalo NY USA
| | - Robert A Wild
- Department of Obstetrics and Gynecology and Biostatistics and Epidemiology University of Oklahoma Health Sciences Center OK Oklahoma City USA
| | - Bernhard Haring
- Department of Cardiology University Heart Center Graz, Medical University of Graz Graz Austria
| | - Kathy Pan
- Department of Hematology/Oncology Kaiser Permanente Southern California CA Downey USA
| | - Hilary A Tindle
- Department of Medicine Vanderbilt University Medical Center TN Nashville USA
| | - Randi Foraker
- Department of Medicine Washington University at St. Louis MO St. Louis USA
| | - Nazmus Saquib
- College of Medicine at Sulaiman Al Rajhi University Bukariyah Saudi Arabia
| | - Ana Barac
- MedStar Heart and Vascular Institute Georgetown University DC Washington USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA
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18
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Golbus JR, Lopez-Jimenez F, Barac A, Cornwell WK, Dunn P, Forman DE, Martin SS, Schorr EN, Supervia M. Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association. Circulation 2023. [PMID: 37272365 DOI: 10.1161/cir.0000000000001150] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiac rehabilitation has strong evidence of benefit across many cardiovascular conditions but is underused. Even for those patients who participate in cardiac rehabilitation, there is the potential to better support them in improving behaviors known to promote optimal cardiovascular health and in sustaining those behaviors over time. Digital technology has the potential to address many of the challenges of traditional center-based cardiac rehabilitation and to augment care delivery. This American Heart Association science advisory was assembled to guide the development and implementation of digital cardiac rehabilitation interventions that can be translated effectively into clinical care, improve health outcomes, and promote health equity. This advisory thus describes the individual digital components that can be delivered in isolation or as part of a larger cardiac rehabilitation telehealth program and highlights challenges and future directions for digital technology generally and when used in cardiac rehabilitation specifically. It is also intended to provide guidance to researchers reporting digital interventions and clinicians implementing these interventions in practice and to advance a framework for equity-centered digital health in cardiac rehabilitation.
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19
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Yogeswaran V, Wadden E, Szewczyk W, Barac A, Simon MS, Eaton C, Cheng RK, Reding KW. A narrative review of heart failure with preserved ejection fraction in breast cancer survivors. Heart 2023:heartjnl-2022-321859. [PMID: 37258098 DOI: 10.1136/heartjnl-2022-321859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/07/2023] [Indexed: 06/02/2023] Open
Abstract
Advances in breast cancer (BC) treatment have contributed to improved survival, but BC survivors experience significant short-term and long-term cardiovascular mortality and morbidity, including an elevated risk of heart failure with preserved ejection fraction (HFpEF). Most research has focused on HF with reduced ejection fraction (HFrEF) after BC; however, recent studies suggest HFpEF is the more prevalent subtype after BC and is associated with substantial health burden. The increased HFpEF risk observed in BC survivors may be explained by treatment-related toxicity and by shared risk factors that heighten risk for both BC and HFpEF. Beyond risk factors with physiological impacts that drive HFpEF risk, such as hypertension and obesity, social determinants of health (SDOH) likely contribute to HFpEF risk after BC, impacting diagnosis, management and prognosis.Increasing clinical awareness of HFpEF after BC and screening for cardiovascular (CV) risk factors, in particular hypertension, may be beneficial in this high-risk population. When BC survivors develop HFpEF, treatment focuses on initiating guideline-directed medical therapy and addressing underlying comorbidities with pharmacotherapy or behavioural intervention. HFpEF in BC survivors is understudied. Future directions should focus on improving HFpEF prevention and treatment by building a deeper understanding of HFpEF aetiology and elucidating contributing risk factors and their pathogenesis in HFpEF in BC survivors, in particular the association with different BC treatment modalities, including radiation therapy, chemotherapy, biological therapy and endocrine therapy, for example, aromatase inhibitors. In addition, characterising how SDOH intersect with these therapies is of paramount importance to develop future prevention and management strategies.
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Affiliation(s)
- Vidhushei Yogeswaran
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Elena Wadden
- Division of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Warren Szewczyk
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Ana Barac
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Michael S Simon
- Medical Oncology, Karmanos Cancer Center, Detroit, Michigan, USA
| | - Charles Eaton
- Family Medicine and Epidemiology Program, Brown University, Providence, Rhode Island, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
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20
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Krishan S, Munir MB, Khan MZ, Al-Juhaishi T, Nipp R, DeSimone CV, Deshmukh A, Stavrakis S, Barac A, Asad ZUA. Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation. Europace 2023; 25:euad129. [PMID: 37208304 PMCID: PMC10198774 DOI: 10.1093/europace/euad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
AIMS Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. METHODS AND RESULTS The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). CONCLUSION Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.
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Affiliation(s)
- Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Muhammad Bilal Munir
- Department of Cardiovascular Medicine, Electrophysiology Section, University of California Davis, Davis, CA, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Taha Al-Juhaishi
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ana Barac
- Cardio Oncology Program, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
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21
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Barac A. Assessing Heart Failure vs Lymphoma Treatment Risks and Benefits-It Takes Two to Tango. JAMA Cardiol 2023; 8:462-463. [PMID: 36988925 DOI: 10.1001/jamacardio.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Ana Barac
- Inova Heart and Vascular Institute, Falls Church, Virginia
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22
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Vo JB, Ramin C, Lawrence W, Barac A, Ho K, Rhee J, Veiga LHS, Berrington De Gonzalez A. Racial and ethnic disparities in treatment-related heart disease mortality among U.S. breast cancer survivors. JNCI Cancer Spectr 2023; 7:7082546. [PMID: 36943362 PMCID: PMC10130190 DOI: 10.1093/jncics/pkad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Racial/ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described. METHODS We included 739,557 women diagnosed with first primary invasive breast cancer between 2000-2017 (aged 18-84 years, received surgery, survived ≥one year, followed through 2018) in the SEER-18 database. Standardized mortality ratios (SMRs; observed/expected) were calculated by race/ethnicity (Non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHP]); Non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and Non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy+surgery; chemotherapy, radiotherapy, +surgery; and radiotherapy+surgery) compared to the racial/ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks. RESULTS SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy+surgery (range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, +surgery (1.29; 95%CI = 1.11,1.48), whereas SMRs were <1 for White women (range = 0.70-0.96). SMRs were especially high for women with advanced (regional/distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy+surgery (range = 1.28-3.61). Non-white women diagnosed at age < 60 had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor positive breast cancers. Black women had the highest ten-year cumulative risk of heart disease mortality: age < 60 (Black : 1.78%; 95%CI = 1.63%,1.94%) compared to White, AANHPI, and Latina women (<1%), and age ≥ 60 (Black : 7.92%; 95%CI = 7.53%,8.33%) compared to White, AANHPI, and Latina women (range = 3.90%-6.48%). CONCLUSIONS Our findings illuminated striking racial/ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt.
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Affiliation(s)
- Jacqueline B Vo
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Cody Ramin
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Wayne Lawrence
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Katherine Ho
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Jongeun Rhee
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lene H S Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Amy Berrington De Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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23
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Barac A, López-Fernández T. An Inconvenient Truth About the LVEF and Cardiac Monitoring in Oncology: Please Don't Shoot the Messenger! JACC Cardiovasc Imaging 2023; 16:279-281. [PMID: 36752437 DOI: 10.1016/j.jcmg.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Ana Barac
- MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA.
| | - Teresa López-Fernández
- La Paz University Hospital, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Research Institute, Madrid, Spain
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24
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Cespedes Feliciano EM, Vasan S, Luo J, Binder AM, Chlebowski RT, Quesenberry C, Banack HR, Caan BJ, Paskett ED, Williams GR, Barac A, LaCroix AZ, Peters U, Reding KW, Pan K, Shadyab AH, Qi L, Anderson GL. Long-term Trajectories of Physical Function Decline in Women With and Without Cancer. JAMA Oncol 2023; 9:395-403. [PMID: 36656572 PMCID: PMC9857739 DOI: 10.1001/jamaoncol.2022.6881] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/05/2022] [Indexed: 01/20/2023]
Abstract
Importance Patients with cancer experience acute declines in physical function, hypothesized to reflect accelerated aging driven by cancer-related symptoms and effects of cancer therapies. No study has examined long-term trajectories of physical function by cancer site, stage, or treatment compared with cancer-free controls. Objective Examine trajectories of physical function a decade before and after cancer diagnosis among older survivors and cancer-free controls. Design, Setting, and Participants This prospective cohort study enrolled patients from 1993 to 1998 and followed up until December 2020. The Women's Health Initiative, a diverse cohort of postmenopausal women, included 9203 incident cancers (5989 breast, 1352 colorectal, 960 endometrial, and 902 lung) matched to up to 5 controls (n = 45 358) on age/year of enrollment and study arm. Exposures Cancer diagnosis (site, stage, and treatment) via Medicare and medical records. Main Outcomes and Measures Trajectories of self-reported physical function (RAND Short Form 36 [RAND-36] scale; range: 0-100, higher scores indicate superior physical function) estimated from linear mixed effects models with slope changes at diagnosis and 1-year after diagnosis. Results This study included 9203 women with cancer and 45 358 matched controls. For the women with cancer, the mean (SD) age at diagnosis was 73.0 (7.6) years. Prediagnosis, physical function declines of survivors with local cancers were similar to controls; after diagnosis, survivors experienced accelerated declines relative to controls, whose scores declined 1 to 2 points per year. Short-term declines in the year following diagnosis were most severe in women with regional disease (eg, -5.3 [95% CI, -6.4 to -4.3] points per year in regional vs -2.8 [95% CI, -3.4 to -2.3] for local breast cancer) or who received systemic therapy (eg, for local endometrial cancer, -7.9 [95% CI, -12.2 to -3.6] points per year with any chemotherapy; -3.1 [95% CI, -6.0 to -0.3] with radiation therapy alone; and -2.6 [95% CI, -4.2 to -1.0] with neither, respectively). While rates of physical function decline slowed in the later postdiagnosis period (eg, women with regional colorectal cancer declined -4.3 [95% CI, -5.9 to -2.6] points per year in the year following diagnosis vs -1.4 [95% CI, -1.7 to -1.0] points per year in the decade thereafter), survivors had estimated physical function significantly below that of age-matched controls 5 years after diagnosis. Conclusions and Relevance In this prospective cohort study, survivors of cancer experienced accelerated declines in physical function after diagnosis, and physical function remained below that of age-matched controls even years later. Patients with cancer may benefit from supportive interventions to preserve physical functioning.
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Affiliation(s)
| | - Sowmya Vasan
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Indiana at Bloomington, Bloomington
| | - Alexandra M. Binder
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu
- Department of Epidemiology, University of California, Los Angeles
| | | | | | - Hailey R. Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, New York
- Epidemiology Division, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Bette J. Caan
- Kaiser Permanente Northern California Division of Research, Oakland
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus
| | - Grant R. Williams
- Institute for Cancer Outcomes and Survivorship, School of Medicine, The University of Alabama at Birmingham, Birmingham
| | - Ana Barac
- Cardio-Oncology Program, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Andrea Z. LaCroix
- Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kerryn W. Reding
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle
| | - Kathy Pan
- Medical Oncology, The Lundquist Institute, Torrance, California
| | - Aladdin H. Shadyab
- Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla
| | - Lihong Qi
- Public Health Sciences, School of Medicine, University of California at Davis, Davis
| | - Garnet L. Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
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25
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Schlam I, Debnath D, Gallagher C, Dilawari AA, Tiwari SR, Aschalew M, Guebre-Xabiher H, Malloy S, Graves K, Barac A, Chitalia A. Abstract P6-05-09: Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Breast cancer (BC) is the most common cancer in women in the United States (US). With advances in screening and treatment, there are increasing numbers of BC survivors. Preexisting or emerging cardiovascular (CV) risk factors and some cancer therapies put BC survivors at risk for long-term CV disease (CVD). ASCO clinical practice guidelines for prevention and monitoring of cardiac dysfunction recommend treatment of CV risk factors in cancer survivors, however, the application of these guidelines in clinical practice presents several challenges. In this pilot study, we describe the feasibility of performing CVD risk assessment in a cohort of BC survivors in a single institution in an urban area that serves mostly Black/African American (AA) populations.
Methods: We identified patients with early-stage BC treated between 2015 and 2022. Patients underwent CVD risk assessment including vital signs, hemoglobin A1c, lipid panel, transthoracic echocardiogram (TTE), 6-minute walk test (6MWT), troponin T, and B-type natriuretic peptide (NT-ProBNP). The primary objective of the study was to describe the feasibility of performing a CVD risk assessment.
Results: Out of 69 eligible patients who were approached for the study, 50 were enrolled and completed the CVD risk assessment (72%). Among 19 patients who did not enroll or complete the risk assessment, time constraints to complete the work up was the predominant factor. The median age was 60.5 years (SD = 13.65; range 34-86), 76% self-identified as Black/AA, 14% as White, and 95% as Non-Hispanic. Half of the patients had hormone-receptor-positive BC, 34% human epidermal growth factor receptor 2 (HER2) positive disease (and received HER2-targeted therapies), and 28% triple-negative breast cancer (TNBC). In terms of treatment, 34% received anthracycline-containing regimens. CVD risk assessment results are shown in Table 1. Twenty-four (48%) of the patients had metabolic syndrome defined as the presence of 3 out of 5 CV risk factors (waist circumference, hypertension, low HDL, high triglycerides, insulin resistance). Although all patients had an ejection fraction (EF) above 55%, 7 patients (14%) had an abnormal global longitudinal strain (GLS). The median number of meters in the 6MWT was 369 (SD 94.46, range 67-531); 74% of patients walked a shorter distance than predicted by age and body mass index, indicating significant physical impairment. All patients had a troponin T value below the 99th percentile. The most frequent modifiable CVD-risk factors included obesity and hypertension.
Conclusion: Performing a low-cost CVD risk assessment in a population of mostly Black/AA BC survivors was feasible in this pilot study. We identified a high prevalence of CVD risk factors, with 48% of patients meeting metabolic syndrome criteria and the majority of patients demonstrated a very high level of functional impairment measured by 6MWT. Our findings underscore the importance of survivorship care focused on CVD risk in BC survivors. Limitations include the small sample size, single-institution study, and lack of CV and BC-related outcomes. The higher incidence of TNBC could be explained by a selection bias of patients receiving cytotoxic chemotherapy and the higher incidence of TNBC in the Black/AA population. Future research will focus on implementing this assessment in the survivorship clinic and establishing interventions to decrease CVD risk in cancer survivors.
Table 1. Clinical Measurements & Outcomes (n=50).
Citation Format: Ilana Schlam, Dipanjan Debnath, Christopher Gallagher, Asma A. Dilawari, Shruti R. Tiwari, Malate Aschalew, Hiwot Guebre-Xabiher, Stacy Malloy, Kristi Graves, Ana Barac, Ami Chitalia. Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-09.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana Barac
- 10MedStar Washington Hospital Center
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Kumar A, Culver A, Singh H, Mudra S, Rizk AA, Agrawal A, Ali SM, Dey A, Klein AL, Reuss J, Barac A. IMMUNE-MEDIATED MYOCARDITIS FOLLOWING SINGLE DOSE OF ADJUVANT ATEZOLIZUMAB: DOES BENEFIT OUTWEIGH RISK? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Meda NS, Smith A, Iyer A, Kallur AS, Gatti J, Barac A, Bering PT. RARE CAUSE OF INTRACARDIAC MASS: EPSTEIN BAR VIRUS RELATED CARDIAC LYMPHOMA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Cogliati M, Arikan-Akdagli S, Barac A, Bostanaru AC, Brito S, Çerikçioğlu N, Efstratiou MA, Ergin Ç, Esposto MC, Frenkel M, Gangneux JP, Gitto A, Gonçalves CI, Guegan H, Gunde-Cimerman N, Güran M, Jonikaitė E, Kataržytė M, Klingspor L, Mares M, Meijer WG, Melchers WJG, Meletiadis J, Nastasa V, Babič MN, Ogunc D, Ozhak B, Prigitano A, Ranque S, Romanò L, Rusu RO, Sabino R, Sampaio A, Silva S, Stephens JH, Tehupeiory-Kooreman M, Velegraki A, Veríssimo C, Segal E, Brandão J. Environmental and bioclimatic factors influencing yeasts and molds distribution along European shores. Sci Total Environ 2023; 859:160132. [PMID: 36400291 DOI: 10.1016/j.scitotenv.2022.160132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
The present study employed data collected during the Mycosands survey to investigate the environmental factors influencing yeasts and molds distribution along European shores applying a species distribution modelling approach. Occurrence data were compared to climatic datasets (temperature, precipitation, and solar radiation), soil datasets (chemical and physical properties), and water datasets (temperature, salinity, and chlorophyll-a concentration) downloaded from web databases. Analyses were performed by MaxEnt software. Results suggested a different probability of distribution of yeasts and molds along European shores. Yeasts seem to tolerate low temperatures better during winter than molds and this reflects a higher suitability for the Northern European coasts. This difference is more evident considering suitability in waters. Both distributions of molds and yeasts are influenced by basic soil pH, probably because acidic soils are more favorable to bacterial growth. Soils with high nitrogen concentrations are not suitable for fungal growth, which, in contrast, are optimal for plant growth, favored by this environment. Finally, molds show affinity with soil rich in nickel and yeasts with soils rich in cadmium resulting in a distribution mainly at the mouths of European rivers or lagoons, where these metals accumulate in river sediments.
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Affiliation(s)
- M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - S Arikan-Akdagli
- Mycology Laboratory at Department of Medical Microbiology of Hacettepe University Medical School, Ankara, Turkey
| | - A Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Faculty of Medicine, University of Belgrade, Serbia
| | - A C Bostanaru
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - S Brito
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - N Çerikçioğlu
- Mycology Laboratory at Department of Medical Microbiology of Marmara University Medical School, Istanbul, Turkey
| | - M A Efstratiou
- Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Greece
| | - Ç Ergin
- Department of Medical Microbiology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - M Frenkel
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J P Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - A Gitto
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - C I Gonçalves
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - H Guegan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - N Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - M Güran
- Faculty of Medicine, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin, Turkey
| | - E Jonikaitė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - M Kataržytė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - L Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Mares
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - W G Meijer
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - W J G Melchers
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - J Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - V Nastasa
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - M Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - D Ogunc
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - B Ozhak
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - S Ranque
- Aix Marseille Univ, IHU-Méditerranée Infection, AP-HM, IRD, SSA, VITROME, Marseille, France
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - R O Rusu
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - R Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - A Sampaio
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), UTAD, Vila Real, Portugal
| | - S Silva
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - J H Stephens
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - M Tehupeiory-Kooreman
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - C Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - E Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for Environmental and Marine Studies (CESAM) - Department of Animal Biology, University of Lisbon, Lisbon, Portugal
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Khan S, Dani SS, Hermann J, Neilan TG, Lenihan DJ, Fradley M, Parikh R, Khan S, Deswal A, Liu J, Barac A, Labib S, Majithia A, Nohria A, Baron SJ, Ganatra S. Safety and efficacy of transcatheter edge-to-edge repair (TEER) in patients with history of cancer. Int J Cardiol Heart Vasc 2023; 44:101165. [PMID: 36820391 PMCID: PMC9938448 DOI: 10.1016/j.ijcha.2022.101165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 01/02/2023]
Abstract
Background Surgical therapy has been a long-standing option for valvular heart disease, in patients with history of cancer, it carries an increased risk of complications. Objectives Transcatheter edge-to-edge repair (TEER) for mitral regurgitation, represents a less invasive option. However, patients with history of cancer have generally been excluded from trials. Methods A retrospective cohort analysis was performed on de-identified, aggregate patient data from the TriNetX research network. Patients 18 ≥ years of age, who had undergone TEER between January 1, 2013 and May 19, 2021, were identified using the CPT codes and divided into two cohorts based on a history of cancer. Subgroup analysis was performed based on history of systemic antineoplastic therapy. Odds ratio and log-rank test were used to compare the outcomes over 1 and 12-months. Results In matched cohorts (503 patients in each, mean age 77.7 years, men 55 vs 58 %, white 84 vs 87 % in non-cancer and cancer cohorts respectively), the risk of heart failure exacerbation, all-cause mortality and all-cause hospitalizations were similar at 1 and 12 months among patients undergoing TEER. Risk of major complications (ischemic stroke, blood product transfusion and cardiac tamponade) were also similar. In the cancer cohort, hematologic/lymphoid malignancies were the most common (28.0 %) and 12.5 % patients had a history of metastatic cancer. There was no significant difference in heart failure exacerbation or all-cause mortality based on history of systemic antineoplastic therapy. Conclusions Overall outcomes following TEER are similar in patients with a history of cancer and should be considered in selected patients in this population.
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Affiliation(s)
- Sahoor Khan
- Interventional Cardiology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Sourbha S Dani
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Joerg Hermann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center (CIRC) and Cardio-Oncology Program, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel J Lenihan
- International Cardio-Oncology Society, Tampa, FL, USA
- St Francis Healthcare, Cape Girardeau, MO, USA
| | - Michael Fradley
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rohan Parikh
- Interventional Cardiology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Saafi Khan
- Department of Cardiovascular Medicine, Houston Methodist, Houston, TX, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Liu
- Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sherif Labib
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Arjun Majithia
- Interventional Cardiology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Anju Nohria
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Cardio-Oncology Program, Dana Farber Cancer Institute, Boston, MA, USA
| | - Suzanne J Baron
- Interventional Cardiology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
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Lee GA, Aktaa S, Baker E, Gale CP, Yaseen IF, Gulati G, Asteggiano R, Szmit S, Cohen-Solal A, Abdin A, Jurczak W, Garrido Lopez P, Sverdlov AL, Tocchetti CG, Barac A, Parrini I, Zamorano P, Iakobishvili Z, Pudil R, Badimon L, Kirby AM, Blaes AH, Farmakis D, Curigliano G, Stephens R, Lyon AR, Lopez-Fernandez T. European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment. Eur Heart J Qual Care Clin Outcomes 2022; 9:1-7. [PMID: 36316010 PMCID: PMC9745663 DOI: 10.1093/ehjqcco/qcac070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022]
Abstract
AIMS To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.
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Affiliation(s)
- G A Lee
- Division of Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - S Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Baker
- Division of Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Israa F Yaseen
- Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
| | - G Gulati
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - R Asteggiano
- School of Medicine, Insubria University, Varese, Italy
- LARC (Laboratorio Analisi e Ricerca Clinica), C.so Venezia 10, Turin, Italy
| | - S Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Otwock, Poland
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - A Cohen-Solal
- Research Medical Unit INSERM U-942, University of Paris, Paris, France
- Cardiology Department, Hôpitaux de Paris, Hôpital Lariboisière 2 Rue Ambroise Paré, Paris, France
| | - A Abdin
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - W Jurczak
- MSC National Research Institute of Oncology, Garnarska 11, 31-115 Krakow, Poland
| | - P Garrido Lopez
- Jefe Servicio Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, Calvary Mater Newcastle, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, NSW, Australia
| | - C G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - A Barac
- Cardio-oncology Program, MedStar Heart and Vascular Institute, Washington DC, USA
| | - I Parrini
- Department of Cardiology, Mauriziano Hospital, Turin, Italy
| | - P Zamorano
- University Hospital Ramon y Cajal, Madrid, Spain
| | - Z Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Tel Aviv Jaffa, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - R Pudil
- University Hospital Hradec Králové, Sokolská 5005, Hradec Králové, Czech Republic
| | - L Badimon
- IIBSant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV, Barcelona, Spain
| | - A M Kirby
- Royal Marsden NHS Trust & Institute of Cancer Research, London, UK
| | - A H Blaes
- Division of Hematology/Oncology/Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - D Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- IRCCS, European Institute of Oncology, Milan, Italy
| | | | - A R Lyon
- National Heart and Lung Institute, Imperial College London, and Cardio-Oncology Service, Royal Brompton Hospital, London, UK
| | - T Lopez-Fernandez
- Cardiology department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
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Reding KW, Cheng RK, Barac A, Vasbinder A, Hovsepyan G, Stefanick M, Simon MS. Toward a Better Understanding of the Differential Impact of Heart Failure Phenotypes After Breast Cancer. J Clin Oncol 2022; 40:3688-3691. [PMID: 35687827 PMCID: PMC9649273 DOI: 10.1200/jco.22.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kerryn W. Reding
- University of Washington School of Nursing Biobehavioral Nursing and Health Informatics Department, Seattle, WA
- Fred Hutch Cancer Center Public Health Sciences Division, Seattle, WA
| | - Richard K. Cheng
- University of Washington School of Medicine, Department of Cardiology, Seattle, WA
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Alexi Vasbinder
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI
| | - Gayane Hovsepyan
- Barbara Ann Karmanos Cancer Institute, Department of Oncology, Detroit, MI
| | - Marcia Stefanick
- Stanford School of Medicine, Stanford Prevention Research Center, Palo Alto, CA
| | - Michael S. Simon
- Barbara Ann Karmanos Cancer Institute, Department of Oncology, Detroit, MI
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Quinaglia T, Gongora C, Awadalla M, Hassan MZO, Zafar A, Drobni ZD, Mahmood SS, Zhang L, Coelho-Filho OR, Suero-Abreu GA, Rizvi MA, Sahni G, Mandawat A, Zatarain-Nicolás E, Mahmoudi M, Sullivan R, Ganatra S, Heinzerling LM, Thuny F, Ederhy S, Gilman HK, Sama S, Nikolaidou S, Mansilla AG, Calles A, Cabral M, Fernández-Avilés F, Gavira JJ, González NS, García de Yébenes Castro M, Barac A, Afilalo J, Zlotoff DA, Zubiri L, Reynolds KL, Devereux R, Hung J, Picard MH, Yang EH, Gupta D, Michel C, Lyon AR, Chen CL, Nohria A, Fradley MG, Thavendiranathan P, Neilan TG. Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis. JACC Cardiovasc Imaging 2022; 15:1883-1896. [PMID: 36357131 PMCID: PMC10334352 DOI: 10.1016/j.jcmg.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/25/2022] [Accepted: 06/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS. OBJECTIVES This study aimed to detail the role of GCS and GRS in ICI myocarditis. METHODS In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. RESULTS Cases and controls were similar in age (66 ± 15 years vs 63 ± 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% ± 3.4% vs 23.5% ± 3.8%; P = 0.14; GRS: 45.5% ± 6.2% vs 43.6% ± 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% ± 4.2% vs 23.6% ± 3.0%; P < 0.001; GRS: 28.6% ± 6.7% vs 47.0% ± 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002). CONCLUSIONS GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.
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Affiliation(s)
- Thiago Quinaglia
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Carlos Gongora
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Magid Awadalla
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malek Z O Hassan
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amna Zafar
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zsofia D Drobni
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Syed S Mahmood
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Otavio R Coelho-Filho
- Discipline of Cardiology, Department of Medicine, Faculty of Medical Science, State University of Campinas, Campinas, Brazil
| | | | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
| | - Gagan Sahni
- Cardiology-Oncology Program, Mount Sinai Hospital, New York, New York, USA
| | - Anant Mandawat
- Cardio-Oncology Program, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eduardo Zatarain-Nicolás
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Michael Mahmoudi
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Lucie M Heinzerling
- Department of Dermatology and Allergy, LMU Klinikum, Munich, Germany and Department of Dermatology, University Hospital Erlangen, Germany
| | - Franck Thuny
- Mediterranean University Center of Cardio-Oncology, Aix-Marseille University, North Hospital, Marseille, France
| | - Stephane Ederhy
- Cardio-Oncology Program, Division of Cardiology, Hopitaux Universitaires Est Parisien, Paris, France
| | - Hannah K Gilman
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Supraja Sama
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sofia Nikolaidou
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ana González Mansilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Antonio Calles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Marcella Cabral
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Juan José Gavira
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | - Nahikari Salterain González
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | | | - Ana Barac
- Cardio-Oncology Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jonathan Afilalo
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Daniel A Zlotoff
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leyre Zubiri
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard Devereux
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Dipti Gupta
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Caroline Michel
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and Imperial College London, London, UK
| | - Carol L Chen
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Clinical cardio-oncology considerations specific to women span across many areas and are particularly relevant for management of patients with sex-specific cancers, such as breast cancer. RECENT FINDINGS Major improvement in breast cancer survivorship over the last decade and the recognition of CV disease as the second leading cause of death among survivors point to the relevance of long-term cardiovascular (CV) safety. This review summarizes the CV effects associated with multimodality breast cancer treatments and contemporary approach to CV risk stratification, prevention, early detection, monitoring, and management at the time of cancer diagnosis, during and after completion of treatment. We highlight the growing role of a multidisciplinary, team-based approach for comprehensive CV and oncology care through the entire cancer treatment continuum, from diagnosis through survivorship.
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Affiliation(s)
- Seyed Ebrahim Kassaian
- J.D. Murphy Jr. Cardio-Oncology Fellowship Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, 110 Irving Street, NW, Suite 1A130, Washington, DC, 20010, USA
| | - Bhumika Gandhi
- Cancer Survivorship Program, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, 110 Irving Street, NW, Suite 1A130, Washington, DC, 20010, USA.
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Baldassarre LA, Ganatra S, Lopez-Mattei J, Yang EH, Zaha VG, Wong TC, Ayoub C, DeCara JM, Dent S, Deswal A, Ghosh AK, Henry M, Khemka A, Leja M, Rudski L, Villarraga HR, Liu JE, Barac A, Scherrer-Crosbie M. Advances in Multimodality Imaging in Cardio-Oncology: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:1560-1578. [PMID: 36229093 DOI: 10.1016/j.jacc.2022.08.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
The population of patients with cancer is rapidly expanding, and the diagnosis and monitoring of cardiovascular complications greatly rely on imaging. Numerous advances in the field of cardio-oncology and imaging have occurred in recent years. This review presents updated and practical approaches for multimodality cardiovascular imaging in the cardio-oncology patient and provides recommendations for imaging to detect the myriad of adverse cardiovascular effects associated with antineoplastic therapy, such as cardiomyopathy, atherosclerosis, vascular toxicity, myocarditis, valve disease, and cardiac masses. Uniquely, we address the role of cardiovascular imaging in patients with pre-existing cardiomyopathy, pregnant patients, long-term survivors, and populations with limited resources. We also address future avenues of investigation and opportunities for artificial intelligence applications in cardio-oncology imaging. This review provides a uniform practical approach to cardiovascular imaging for patients with cancer.
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Affiliation(s)
- Lauren A Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarju Ganatra
- Cardio-Oncology and Cardiac MRI Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Juan Lopez-Mattei
- Cardiovascular Imaging Program, Department of Cardiovascular Medicine, Lee Health, Fort Myers, Florida, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy C Wong
- UPMC Cardiovascular Magnetic Resonance Center, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chadi Ayoub
- Division of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M DeCara
- Cardio-Oncology Program, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, University College London Hospital and Hatter Cardiovascular Institute, London, United Kingdom
| | - Mariana Henry
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abhishek Khemka
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lawrence Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer E Liu
- Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Ganatra S, Dani SS, Kumar A, Khan SU, Wadhera R, Neilan TG, Thavendiranathan P, Barac A, Hermann J, Leja M, Deswal A, Fradley M, Liu JE, Sadler D, Asnani A, Baldassarre LA, Gupta D, Yang E, Guha A, Brown SA, Stevens J, Hayek SS, Porter C, Kalra A, Baron SJ, Ky B, Virani SS, Kazi D, Nasir K, Nohria A. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol 2022; 4:326-337. [PMID: 36213357 PMCID: PMC9537091 DOI: 10.1016/j.jaccao.2022.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Safi U. Khan
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Rishi Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center and Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology and Joint Division of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ana Barac
- Cardio-Oncology Program, Department of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, District of Columbia, USA
| | - Joerg Hermann
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anita Deswal
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Fradley
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Diego Sadler
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Aarti Asnani
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lauren A. Baldassarre
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Yale New Haven Hospital, Yale University, New Haven, Connecticut, USA
| | - Dipti Gupta
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eric Yang
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Salim S. Hayek
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Porter
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Suzanne J. Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Bonnie Ky
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salim S. Virani
- Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Health Services Research and Development Center of Excellence and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Dhruv Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Anju Nohria
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Aghayev A, Cheezum MK, Steigner ML, Mousavi N, Padera R, Barac A, Kwong RY, Di Carli MF, Blankstein R. Multimodality imaging to distinguish between benign and malignant cardiac masses. J Nucl Cardiol 2022; 29:1504-1517. [PMID: 34476778 DOI: 10.1007/s12350-021-02790-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/25/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND To compare the diagnostic accuracy of CMR and FDG-PET/CT and their complementary role to distinguish benign vs malignant cardiac masses. METHODS Retrospectively assessed patients with cardiac mass who underwent CMR and FDG-PET/CT within a month between 2003 and 2018. RESULTS 72 patients who had CMR and FDG-PET/CT were included. 25 patients (35%) were diagnosed with benign and 47 (65%) were diagnosed with malignant masses. 56 patients had histological correlation: 9 benign and 47 malignant masses. CMR and FDG-PET/CT had a high accuracy in differentiating benign vs malignant masses, with the presence of CMR features demonstrating a higher sensitivity (98%), while FDG uptake with SUVmax/blood pool ≥ 3.0 demonstrating a high specificity (88%). Combining multiple (> 4) CMR features and FDG uptake (SUVmax/blood pool ratio ≥ 3.0) yielded a sensitivity of 85% and specificity of 88% to diagnose malignant masses. Over a mean follow-up of 2.6 years (IQR 0.3-3.8 years), risk-adjusted mortality were highest among patients with an infiltrative border on CMR (adjusted HR 3.1; 95% CI 1.5-6.5; P = .002) or focal extracardiac FDG uptake (adjusted HR 3.8; 95% CI 1.9-7.7; P < .001). CONCLUSION Although CMR and FDG-PET/CT can independently diagnose benign and malignant masses, the combination of these modalities provides complementary value in select cases.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Negareh Mousavi
- Cardiovascular Division, McGill University Health Center, Montreal, QC, Canada
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Chlebowski RT, Aragaki AK, Pan K, Nelson RA, Barac A, Manson JE, Stefanick ML, Ikramuddin F, Johnson K, Krok-Schoen JL, Laddu D, Pichardo MS, Snetselaar L, LeBoff M, Michael Y. Dietary influence on physical functioning in the Women’s Health Initiative (WHI) randomized Dietary Modification (DM) trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10552 Background: In the WHI DM randomized trial, randomization to the dietary intervention group was associated with a 21% lower breast cancer mortality (P = 0.02) (JCO 2020), and while not an intervention target, with higher physical activity as well. Therefore, we examined whether these lifestyle changes attenuate age-related physical functioning decline. Methods: From 1993-1998, 48,835 postmenopausal women, aged 50-79 years, were randomized to dietary intervention or usual diet comparison groups through 8 years intervention and 19 years cumulative follow-up. Breast cancer findings, as primary outcome, have been reported. Physical functioning was assessed using the RAND 36-Item Short Form Health Survey (SF-36), which assessed limitations of 10 hierarchical physical activities, scored from 0 to 100, with a higher score indicating less limited physical function. The trajectory of longitudinal physical functioning was the primary study outcome, assessed by comparing findings in the two randomization groups, overall, and by baseline physical activity and age decade. Additionally, findings were reported against a disability threshold (when assistance in daily activities is required). Results: Physical functioning was assessed nearly half a million times during the study (n = 495,317) with 11.0 (median) assessments per participant. Physical functioning score was significantly better in the intervention versus comparison groups during the 8-year intervention and extended follow-up through 12 years (median) (P = 0.001), representing a reduction in age-related functional decline. The intervention effect subsequently lost significance at 19 years and both randomization groups crossed the disability threshold at similar times. Differences between randomization groups in physical functioning emerged after stratification by physical activity and age decade (P-interaction = 0.007). Among all participants physically active at entry, the intervention initially had a statistically significant, favorable influence on physical functioning which attenuated post-intervention. In contrast, among younger, physically inactive women 50-59 years of age, the intervention had a persistent, statistically significant, favorable influence on physical functioning with associated delay in crossing the disability threshold. Conclusions: In the primary prevention setting of the WHI DM randomized trial, with long-term follow-up, a dietary intervention which has been shown to reduce breast cancer mortality also significantly reduced age-related functional decline through 12 years. Among all participants, the intervention effect was attenuated with longer follow-up. However, reduction in age-related functional decline was sustained in younger women in the intervention group who were inactive at entry, a potential target population for future behavior interventions. Clinical trial information: NCT00000611.
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Affiliation(s)
- Rowan T. Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance,, Duarte, CA
| | - Aaron K. Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC
| | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | | | - Karen Johnson
- University of Tennessee Health Science Center, Memphis, TN
| | - Jessica L. Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Deepika Laddu
- University of Illinois Chicago College of Applied Health Sciences, Chicago, IL
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Uddin MM, Zhou Y, Bick AG, Burugula BB, Jaiswal S, Desai P, Honigberg MC, Love SA, Barac A, Hayden KM, Manson JE, Whitsel EA, Kooperberg C, Natarajan P, Reiner AP, Kitzman JO. Longitudinal profiling of clonal hematopoiesis provides insight into clonal dynamics. Immun Ageing 2022; 19:23. [PMID: 35610705 PMCID: PMC9128083 DOI: 10.1186/s12979-022-00278-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Clonal hematopoiesis of indeterminate potential (CHIP), the age-related expansion of mutant hematopoietic stem cells, confers risk for multiple diseases of aging including hematologic cancer and cardiovascular disease. Whole-exome or genome sequencing can detect CHIP, but due to those assays' high cost, most population studies have been cross-sectional, sequencing only a single timepoint per individual. RESULTS We developed and validated a cost-effective single molecule molecular inversion probe sequencing (smMIPS) assay for detecting CHIP, targeting the 11 most frequently mutated genes in CHIP along with 4 recurrent mutational hotspots. We sequenced 548 multi-timepoint samples collected from 182 participants in the Women's Health Initiative cohort, across a median span of 16 years. We detected 178 driver mutations reaching variant allele frequency ≥ 2% in at least one timepoint, many of which were detectable well below this threshold at earlier timepoints. The majority of clonal mutations (52.1%) expanded over time (with a median doubling period of 7.43 years), with the others remaining static or decreasing in size in the absence of any cytotoxic therapy. CONCLUSIONS Targeted smMIPS sequencing can sensitively measure clonal dynamics in CHIP. Mutations that reached the conventional threshold for CHIP (2% frequency) tended to continue growing, indicating that after CHIP is acquired, it is generally not lost. The ability to cost-effectively profile CHIP longitudinally will enable future studies to investigate why some CHIP clones expand, and how their dynamics relate to health outcomes at a biobank scale.
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Affiliation(s)
- Md Mesbah Uddin
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Ying Zhou
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Siddhartha Jaiswal
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Michael C Honigberg
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Shelly-Ann Love
- Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ana Barac
- Department of Cardiology, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexander P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98109, USA
| | - Jacob O Kitzman
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
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Abdelfattah OM, Sayed AS, Munir M, Shazly O, Awad AK, Ghaith HS, Gerew M, Guha A, Barac A, Fradley MG, Abela GS, Addison D. Effectiveness of empiric cardioprotective therapy in patients receiving cardiotoxic chemotherapies: systematic review & bayesian network meta-analysis. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardioprotective therapies represent an important avenue to reduce these limiting toxicities, including serious heart failure (HF) events. However, due to conflicting isolated reports, the true efficacy and optimal cardioprotective therapy at the time of anticancer treatment initiation is unclear. Therefore, we undertook a network meta-analysis to elucidate the most effective therapies at cardiotoxic HF prevention.
Purpose
To determine the efficacy, and optimal cardioprotective strategy in patients receiving cardiotoxic chemotherapies.
Methods
Leveraging the MEDLINE/Pubmed, CENTRAL, and clinicaltrials.gov databases, we identified all randomized controlled trials (RCTs) investigating cardioprotective therapies from inception to November 2021. Eligible cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins, and mineralocorticoid receptor antagonists (MRA). The primary endpoint was the prevention of new-onset HF. The secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, the incidence of hypotension, and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were undertaken using a Bayesian random-effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI).
Results
Overall, from 726 articles, 39 studies evaluating 5,931 participants (38.0±19.1 years, 72.0% females) were identified. Over a median follow-up of 6 months, use of any cardioprotective strategy was associated with a significant reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), and increased hypotension (RR:3.27; 95% CrI:1.38-9.87); there was no difference in mortality (RR:1.03; 95% CrI:0.84-1.22). Based on the median risk of incident HF in the control groups being 3.28%, the number need to treat (NNT) for "any" cardioprotective therapy to prevent one incident HF event was 45 patients. For dexrazoxane and neurohormonal agents, the median NNT was 36 and 53 patients, respectively. In this network analysis, dexrazoxane was most effective at HF prevention [Surface Under the Cumulative Ranking curve (SUCRA): 81.47%] and MRA most effective at preserving LVEF (SUCRA: 99.22%). ARBs most greatly increased hypotension (RR:7.20; 95% CrI:2.46-26.94).
Conclusion
Cardiotoxicity remains a challenge for cancer patients requiring life-saving cancer therapies. The initiation of a cardioprotective strategy reduces incident HF. Additional head-to-head trials are needed to confirm the optimal preventative strategy.
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Affiliation(s)
- OM Abdelfattah
- Morristown Medical Center, Morristown, United States of America
| | - AS Sayed
- Ain Shams University, Cairo, Egypt
| | - M Munir
- Ain Shams University, Cairo, Egypt
| | - O Shazly
- Ain Shams University, Cairo, Egypt
| | - AK Awad
- Ain Shams University, Cairo, Egypt
| | - HS Ghaith
- Al-Azhar University, Faculty of Medicine, Cairo, Egypt
| | - M Gerew
- Morristown Medical Center, Morristown, United States of America
| | - A Guha
- University Hospitals Cleveland Medical Center, Department of CardioOncology, Cleveland, United States of America
| | - A Barac
- MedStar Heart and Vascular Institute, Cardio-Oncology Program, Washington, DC, United States of America
| | - MG Fradley
- University of Pennsylvania, Cardio-Oncology Center of Excellence, Division of Cardiology, Philadelphia, United States of America
| | - GS Abela
- Michigan State University, Department of Cardiovascular Medicine, East Lansing, United States of America
| | - D Addison
- Ohio State University Wexner Medical Center, Division of CardioOncology, Department of Cardiovascular Medicine, Columbus, United States of America
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40
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Sayed A, Abdelfattah OM, Munir M, Shazly O, Awad AK, Ghaith HS, Moustafa K, Gerew M, Guha A, Barac A, Fradley MG, Abela GS, Addison D. Long-term effectiveness of empiric cardio-protection in patients receiving cardiotoxic chemotherapies: A systematic review & bayesian network meta-analysis. Eur J Cancer 2022; 169:82-92. [PMID: 35524992 DOI: 10.1016/j.ejca.2022.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cardioprotective therapies represent an important avenue to reduce treatment-limiting cardiotoxicities in patients receiving chemotherapy. However, the optimal duration, strategy and long-term efficacy of empiric cardio-protection remains unknown. METHODS Leveraging the MEDLINE/Pubmed, CENTRAL and clinicaltrials.gov databases, we identified all randomised controlled trials investigating cardioprotective therapies from inception to November 2021 (PROSPERO-ID:CRD42021265006). Cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins and mineralocorticoid receptor antagonists. The primary end-point was new-onset heart failure (HF). Secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, hypotension and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were performed using a Bayesian random effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI). RESULTS Overall, from 726 articles, 39 trials evaluating 5931 participants (38.0 ± 19.1 years, 72.0% females) were identified. The use of any cardioprotective strategy associated with reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), increased hypotension (RR:3.27; 95% CrI:1.38-9.87) and no difference in mortality. Based on control arms, the number-needed-to-treat for 'any' cardioprotective therapy to prevent one incident HF event was 45, including a number-needed-to-treat of 21 with ≥1 year of therapy. Dexrazoxane was most effective at HF prevention (Surface Under the Cumulative Ranking curve: 81.47%), and mineralocorticoid receptor antagonists were most effective at preserving LVEF (Surface Under the Cumulative Ranking curve: 99.22%). CONCLUSION Cardiotoxicity remains a challenge for patients requiring anticancer therapies. The initiation of extended duration cardioprotection reduces incident HF. Additional head-to-head trials are needed.
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Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Omar M Abdelfattah
- Department of Medicine, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USA.
| | - Malak Munir
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar Shazly
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Khaled Moustafa
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maria Gerew
- Department of Medicine, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USA
| | - Avirup Guha
- Cardio-Oncology Program, Georgia Cancer Center, Medical College of Georgia at Augusta University, Augusta, GA, USA; Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Ana Barac
- Cardio-Oncology Program, Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - George S Abela
- Department of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA; Division of Cancer Control and Prevention, James Cancer Hospital and Solove Research Institute at the Ohio State University, Columbus, OH, USA.
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41
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Affiliation(s)
- Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardio-Oncology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC.,National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Washington, DC
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42
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Zhang I, Barac A. Cardioprotection for Anti-HER2 Therapy: Considerations for Primary Prevention and Use in Mildly Reduced Left Ventricular Ejection Fraction. Curr Oncol Rep 2022; 24:1063-1070. [PMID: 35362825 DOI: 10.1007/s11912-022-01234-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes current HER2-targeted therapies and clinical studies that have investigated primary and secondary prevention of cardiac dysfunction for HER2 + breast cancer patients undergoing targeted therapy. RECENT FINDINGS Primary and secondary prevention clinical trials highlight the importance of cardioprotective measures during HER2 + cancer treatment. Together, these studies suggest the safety of neurohormonal drugs, the importance for an individualized approach in starting cardiopreventive therapies, and the potential to expand HER2 + treatment options to patients with cardiac dysfunction. Cardiac dysfunction is a concerning adverse effect for HER2-targeted treatment. The goal of primary and secondary prevention is to prevent (further) cardiac function decline and heart failure symptoms, while delivering appropriate cancer therapy. Clinical trials investigating preventative therapies in the context of primary and secondary prevention are paving the path for reducing adverse cardiac effects and expanding treatment options for patients previously unable to undergo HER + therapy.
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Affiliation(s)
- Irma Zhang
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ana Barac
- Georgetown University School of Medicine, Washington, DC, USA. .,Medstar Washington Hospital Center, 110 Irving Street, NW, Ste 1A130, Washington, DC, 20010, USA. .,National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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43
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Barac A. Cardiovascular toxicities of chemotherapies: challenging the paradigm for left ventricular ejection fraction monitoring during and after treatment. Am Heart J Plus 2022; 16:100140. [PMID: 38559280 PMCID: PMC10976278 DOI: 10.1016/j.ahjo.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 04/04/2024]
Affiliation(s)
- Ana Barac
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, United States of America
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
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44
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Kabir R, Qamer SZ, Shadman S, Ben-Dor I, Slack MC, Shults CC, Nayar V, Weinberg B, Barac A. RECURRENT CARDIAC MYXOMA COMPLICATED BY BRAIN METASTASES: ROLE OF MULTIMODALITY IMAGING IN DIAGNOSIS AND MANAGEMENT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Reding KW, Cheng RK, Vasbinder A, Ray RM, Barac A, Eaton CB, Saquib N, Shadyab AH, Simon MS, Langford D, Branch M, Caan B, Anderson G. Lifestyle and Cardiovascular Risk Factors Associated With Heart Failure Subtypes in Postmenopausal Breast Cancer Survivors. JACC CardioOncol 2022; 4:53-65. [PMID: 35492810 PMCID: PMC9040098 DOI: 10.1016/j.jaccao.2022.01.099] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/05/2022] [Indexed: 12/14/2022] Open
Abstract
Background Breast cancer (BC) survivors experience an increased burden of long-term comorbidities, including heart failure (HF). However, there is limited understanding of the risk for the development of HF subtypes, such as HF with preserved ejection fraction (HFpEF), in BC survivors. Objectives This study sought to estimate the incidence of HFpEF and HF with reduced ejection fraction (HFrEF) in postmenopausal BC survivors and to identify lifestyle and cardiovascular risk factors associated with HF subtypes. Methods Within the Women’s Health Initiative, participants with an adjudicated diagnosis of invasive BC were followed to determine the incidence of hospitalized HF, for which adjudication procedures determined left ventricular ejection fraction. We calculated cumulative incidences of HF, HFpEF, and HFrEF. We estimated HRs for risk factors in relation to HF, HFpEF, and HFrEF using Cox proportional hazards survival models. Results In 2,272 BC survivors (28.6% Black and 64.9% White), the cumulative incidences of hospitalized HFpEF and HFrEF were 6.68% and 3.96%, respectively, over a median of 7.2 years (IQR: 3.6-12.3 years). For HFpEF, prior myocardial infarction (HR: 2.83; 95% CI: 1.28-6.28), greater waist circumference (HR: 1.99; 95% CI: 1.14-3.49), and smoking history (HR: 1.65; 95% CI: 1.01-2.67) were the strongest risk factors in multivariable models. With the exception of waist circumference, similar patterns were observed for HFrEF, although none were significant. In relation to those without HF, the risk of overall mortality in BC survivors with hospitalized HFpEF was 5.65 (95% CI: 4.11-7.76), and in those with hospitalized HFrEF, it was 3.77 (95% CI: 2.51-5.66). Conclusions In this population of older, racially diverse BC survivors, the incidence of HFpEF, as defined by HF hospitalizations, was higher than HFrEF. HF was also associated with an increased mortality risk. Risk factors for HF were largely similar to the general population with the exception of prior myocardial infarction for HFpEF. Notably, both waist circumference and smoking represent potentially modifiable factors.
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Key Words
- BC, breast cancer
- BMI, body mass index
- CVD, cardiovascular disease
- ER, estrogen receptor
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- PR, progesterone receptor
- WHI, Women’s Health Initiative
- breast cancer
- cancer survivorship
- cardio-oncology
- heart failure
- obesity
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Affiliation(s)
- Kerryn W Reding
- Biobehavioral Nursing and Health Informatics Department, University of Washington School of Nursing, Seattle, Washington, USA.,Public Health Sciences Division, Fred Hutch Cancer Research Center, Seattle, Washington, USA
| | - Richard K Cheng
- Department of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexi Vasbinder
- Biobehavioral Nursing and Health Informatics Department, University of Washington School of Nursing, Seattle, Washington, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Roberta M Ray
- Public Health Sciences Division, Fred Hutch Cancer Research Center, Seattle, Washington, USA
| | - Ana Barac
- MedStar Health Heart and Vascular Institute, Baltimore, Maryland, USA.,Division of Cardiology, Georgetown University School of Medicine, Washington, DC, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Nazmus Saquib
- Sulaiman AlRajhi University, Al Qassim, Saudi Arabia
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, California, USA
| | - Michael S Simon
- Division of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Dale Langford
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mary Branch
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bette Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Garnet Anderson
- Public Health Sciences Division, Fred Hutch Cancer Research Center, Seattle, Washington, USA
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46
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Vo JB, Ramin C, Barac A, Berrington de Gonzalez A, Veiga L. Trends in heart disease mortality among breast cancer survivors in the US, 1975-2017. Breast Cancer Res Treat 2022; 192:611-622. [PMID: 35107712 PMCID: PMC8960573 DOI: 10.1007/s10549-022-06515-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
Purpose Heart disease is a significant concern among breast cancer survivors, in part due to cardiotoxic treatments including chemotherapy and radiotherapy. Long-term trends in heart disease mortality have not been well characterized. We examined heart disease mortality trends among US breast cancer survivors by treatment type. Methods We included first primary invasive breast cancer survivors diagnosed between 1975 and 2016 (aged 18–84; survived 12 + months; received initial chemotherapy, radiotherapy, or surgery) in the SEER-9 Database. Standardized mortality ratios (SMRs) and 10-year cumulative heart disease mortality estimates accounting for competing events were calculated by calendar year of diagnosis and initial treatment regimen. Ptrends were assessed using Poisson regression. All statistical tests were 2-sided. Results Of 516,916 breast cancer survivors, 40,812 died of heart disease through 2017. Heart disease SMRs declined overall from 1975–1979 to 2010–2016 (SMR 1.01 [95%CI: 0.98, 1.03] to 0.74 [0.69, 0.79], ptrend < 0.001). This decline was also observed for survivors treated with radiotherapy alone and chemotherapy plus radiotherapy. A sharper decline in heart disease SMRs was observed from 1975 to 1989 for left-sided radiotherapy, compared to right-sided. In contrast, there was a non-significant increasing trend in SMRs for chemotherapy alone, and significant by regional stage (ptrend = 0.036). Largest declines in 10-year cumulative mortality were observed from 1975–1984 to 2005–2016 among surgery only: 7.02% (95%CI: 6.80%, 7.23%) to 4.68% (95%CI: 4.39%, 4.99%) and radiotherapy alone: 6.35% (95%CI: 5.95%, 6.77%) to 2.94% (95%CI: 2.73%, 3.16%). Conclusions We observed declining heart disease mortality trends by most treatment types yet increasing for regional stage patients treated with chemotherapy alone, highlighting a need for additional studies with detailed treatment data and cardiovascular management throughout cancer survivorship. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06515-5.
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Affiliation(s)
- Jacqueline B Vo
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. .,Cancer Prevention Fellowship Program, Division of Cancer Prevention, Bethesda, MD, USA.
| | - Cody Ramin
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ana Barac
- Director of Cardio-Oncology and Professor of Medicine, Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lene Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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47
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Raychaudhuri S, Dieli-Conwright CM, Cheng RK, Barac A, Reding KW, Vasbinder A, Cook KL, Nair V, Desai P, Simon MS. A review of research on the intersection between breast cancer and cardiovascular research in the Women's Health Initiative (WHI). Front Oncol 2022; 12:1039246. [PMID: 37025252 PMCID: PMC10071996 DOI: 10.3389/fonc.2022.1039246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 04/08/2023] Open
Abstract
Both obesity and metabolic syndrome are linked to increased incidence of type 2 diabetes, cardiovascular disease (CVD), and cancers of the breast (post-menopausal), and other obesity-related cancers. Over the past 50 years, the worldwide prevalence of obesity and metabolic syndrome has increased, with a concomitant higher incidence of associated co-morbidities and mortality. The precise mechanism linking metabolic syndrome to increased cancer incidence is incompletely understood, however, individual components of metabolic syndrome have been linked to increased breast cancer incidence and worse survival. There is a bidirectional relationship between the risk of CVD and cancer due to a high burden of shared risk factors and higher rates of CVD among cancer survivors, which may be impacted by the pro-inflammatory microenvironment associated with metabolic syndrome and cancer-directed therapies. The Women's Health Initiative (WHI) is an excellent resource to study a dual relationship between cancer and CVD (cardio-oncology) with extensive information on risk factors and long-term outcomes. The purpose of this review is to provide an overview of research on cardio-oncology conducted utilizing WHI data with focus on studies evaluating both breast cancer and CVD including shared risk factors and outcomes after cancer. The review also includes results on other obesity related cancers which were included in the analyses of breast cancer, articles looking at cancer after heart disease (reverse cardio-oncology) and the role of Clonal Hematopoiesis of Indeterminate Potential (CHIP) as a shared risk factor between CVD and cancer. A summary of pertinent WHI literature helps to delineate the direction of future research evaluating the relationship between CVD and other cancer sites, and provides information on the opportunity for other novel analyses within the WHI.
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Affiliation(s)
- Sreejata Raychaudhuri
- Department of Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- *Correspondence: Sreejata Raychaudhuri,
| | | | - Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, United States
| | - Kerryn W. Reding
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Alexi Vasbinder
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katherine L. Cook
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Vidhya Nair
- Department of Hematology/Oncology, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, MI, United States
| | - Pinkal Desai
- Department of Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Michael S. Simon
- Department of Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
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48
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Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, Carver J, Dent S, Ky B, Lyon AR, López-Fernández T, Fradley MG, Ganatra S, Curigliano G, Mitchell JD, Minotti G, Lang NN, Liu JE, Neilan TG, Nohria A, O'Quinn R, Pusic I, Porter C, Reynolds KL, Ruddy KJ, Thavendiranathan P, Valent P. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J 2021; 43:280-299. [PMID: 34904661 PMCID: PMC8803367 DOI: 10.1093/eurheartj/ehab674] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/28/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022] Open
Abstract
The discipline of Cardio-Oncology has seen tremendous growth over the past decade. It is devoted to the cardiovascular (CV) care of the cancer patient, especially to the mitigation and management of CV complications or toxicities of cancer therapies, which can have profound implications on prognosis. To that effect, many studies have assessed CV toxicities in patients undergoing various types of cancer therapies; however, direct comparisons have proven difficult due to lack of uniformity in CV toxicity endpoints. Similarly, in clinical practice, there can be substantial differences in the understanding of what constitutes CV toxicity, which can lead to significant variation in patient management and outcomes. This document addresses these issues and provides consensus definitions for the most commonly reported CV toxicities, including cardiomyopathy/heart failure and myocarditis, vascular toxicity, and hypertension, as well as arrhythmias and QTc prolongation. The current document reflects a harmonizing review of the current landscape in CV toxicities and the definitions used to define these. This consensus effort aims to provide a structure for definitions of CV toxicity in the clinic and for future research. It will be important to link the definitions outlined herein to outcomes in clinical practice and CV endpoints in clinical trials. It should facilitate communication across various disciplines to improve clinical outcomes for cancer patients with CV diseases.
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Affiliation(s)
- Joerg Herrmann
- Corresponding author. Tel: +1 507 284 2904, Fax: +1 507 293 0107,
| | - Daniel Lenihan
- International Cardio-Oncology Society, 465 Lucerne Ave., Tampa, FL 33606, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Department of Population Sciences, 500 E Duarte Rd, Duarte, CA 91010, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, 10 Irving Street Northwest Suite NW, Washington, DC 20010, USA
| | - Anne Blaes
- University of Minnesota, Division of Hematology/Oncology, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Joseph Carver
- Abraham Cancer Center, University of Pennsylvania, Philadelphia, 3400 Civic Center Boulevard, Pavilion 2nd Floor, Philadelphia, PA 19104, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, 20 Duke Medicine Circle, Durham, NA 27704, USA
| | - Bonnie Ky
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Imperial College, Sydney St, London SW3 6NP, United Kingdom
| | - Teresa López-Fernández
- Division of Cardiology; Cardiac Imaging and Cardio-Oncology Unit; La Paz University Hospital, IdiPAZ Research Institute, CIBER CV, C. de Pedro Rico, 6, 28029 Madrid, Spain
| | - Michael G Fradley
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Via Festa del Perdono 7. 20122 Milano, Italy,European Institute of Oncology, IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Washington University, 4921 Parkview Pl, St. Louis, MO 63110, USA
| | - Giorgio Minotti
- Department of Medicine, University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Ninian N Lang
- British Heart Foundation Centre for Cardiovascular Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA Scotland, United Kingdom
| | - Jennifer E Liu
- Memorial Sloan Kettering Cancer Center, Department of Medicine/Cardiology Service, 1275 York Ave, New York, NY 10065, USA
| | - Tomas G Neilan
- Cardio-oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Anju Nohria
- Cardio-Oncology Program, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Rupal O'Quinn
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Iskra Pusic
- Washington University School of Medicine, Division of Oncology, 4921 Parkview Place, St. Louis, MO 63110, USA
| | - Charles Porter
- Cardiovascular Medicine, Cardio-Oncology Unit, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS 66160, USA
| | - Kerry L Reynolds
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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49
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Barac A, Sharon E. From Detecting Signals to Understanding Cardiovascular Toxicities of Cancer Therapies: All the Light We Could See. J Am Coll Cardiol 2021; 78:1814-1816. [PMID: 34711340 DOI: 10.1016/j.jacc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Ana Barac
- Medstar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
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50
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Wu P, Jordan KP, Chew-Graham CA, Mohamed MO, Barac A, Lundberg GP, Chappell LC, Michos ED, Maas AHEM, Mamas MA. In-Hospital Complications in Pregnant Women With Current or Historical Cancer Diagnoses. Mayo Clin Proc 2021; 96:2779-2792. [PMID: 34272068 DOI: 10.1016/j.mayocp.2021.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the temporal trends, characteristics and comorbidities, and in-hospital cardiovascular and obstetric complications and outcomes of pregnant women with current or historical cancer diagnosis at the time of admission for delivery. METHODS We analyzed delivery hospitalizations with or without current or historical cancer between January 1, 2004, and December 31, 2014, from the US National Inpatient Sample database. RESULTS We included 43,132,097 delivery hospitalizations with no cancer, 39,118 with current cancer, and 67,336 with historical diagnosis of cancer. The 5 most common types of current cancer were hematologic, thyroid, cervical, skin, and breast cancer. Women with current and historical cancer were older (29 years and 32 years vs 27 years) and incurred higher hospital costs ($4131 and $4078 vs $3521) compared with women without cancer. Most of the cancer types were associated with preterm birth (hematologic: adjusted odds ratio [aOR], 1.48 [95% CI, 1.35 to 1.62]; cervical: aOR, 1.47 [95% CI, 1.32 to 1.63]; breast: aOR, 1.93 [95% CI, 1.72 to 2.16]). Current hematologic cancer was associated with the highest risk of peripartum cardiomyopathy (aOR, 12.19 [95% CI, 7.75 to 19.19]), all-cause mortality (aOR, 6.50 [95% CI, 2.22 to 19.07]), arrhythmia (aOR, 3.82 [95% CI, 2.04 to 7.15]), and postpartum hemorrhage (aOR, 1.31 [95% CI, 1.11 to 1.54]). Having a current or historical cancer diagnosis did not confer additional risk for stillbirth; however, metastases increased the risk of maternal mortality and preterm birth. CONCLUSION Women with a current or historical diagnosis of cancer at delivery have more comorbidities compared with women without cancer. Clinicians should communicate the risks of multisystem complications to these complex patients.
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Affiliation(s)
- Pensée Wu
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Staffordshire, United Kingdom; Academic Unit of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
| | - Kelvin P Jordan
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Staffordshire, United Kingdom; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele University, Staffordshire, United Kingdom
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Staffordshire, United Kingdom; The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Ana Barac
- Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Gina P Lundberg
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA; Emory Women's Heart Center, Atlanta, GA
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, London, United Kingdom
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angela H E M Maas
- Department of Cardiology, Women's Cardiac Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Staffordshire, United Kingdom; The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
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