1
|
Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
Collapse
|
2
|
Ergas IJ, Cheng RK, Roh JM, Kushi LH, Kresovich JK, Iribarren C, Nguyen-Huynh M, Rana JS, Rillamas-Sun E, Laurent CA, Lee VS, Quesenberry CP, Greenlee H, Kwan ML. Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study. JNCI Cancer Spectr 2024; 8:pkae013. [PMID: 38627946 PMCID: PMC11021810 DOI: 10.1093/jncics/pkae013] [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: 12/21/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Women with breast cancer are at higher risk of cardiovascular disease (CVD) compared with women without breast cancer. Whether higher diet quality at breast cancer diagnosis lowers this risk remains unknown. We set out to determine if higher diet quality at breast cancer diagnosis was related to lower risk of CVD and CVD-related death. METHODS This analysis included 3415 participants from the Pathway Study, a prospective cohort of women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and followed through December 31, 2021. Scores from 5 diet quality indices consistent with healthy eating were obtained at the time of breast cancer diagnosis. Scores were categorized into ascending quartiles of concordance for each diet quality index, and multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. P values were 2-sided. RESULTS The Dietary Approaches to Stop Hypertension diet quality index was associated with lower risk of heart failure (HR = 0.53, 95% CI = 0.33 to 0.87; Ptrend = .03), arrhythmia (HR = 0.77, 95% CI = 0.62 to 0.94; Ptrend = .008), cardiac arrest (HR = 0.77, 95% CI = 0.61 to 0.96; Ptrend = .02), valvular heart disease (HR = 0.79, 95% CI = 0.64 to 0.98; Ptrend = .046), venous thromboembolic disease (HR = 0.75, 95% CI = 0.60 to 0.93; Ptrend = .01), and CVD-related death (HR = 0.70, 95% CI = 0.50 to 0.99; Ptrend = .04), when comparing the highest with lowest quartiles. Inverse associations were also found between the healthy plant-based dietary index and heart failure (HR = 0.60, 95% CI = 0.39 to 0.94; Ptrend = .02), as well as the alternate Mediterranean dietary index and arrhythmia (HR = 0.74, 95% CI = 0.60 to 0.93; Ptrend = .02). CONCLUSION Among newly diagnosed breast cancer patients, higher diet quality at diagnosis was associated with lower risk of CVD events and death.
Collapse
Affiliation(s)
- Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Oakland Medical Center, Oakland, CA, USA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Heather Greenlee
- University of Washington Medical Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
3
|
Drazner MH, Ambardekar AV, Berlacher K, Blumer V, Chatur S, Cheng R, Cheng RK, Grandin EW, Gorodeski EZ, Kataria R, Katz JN, Kittleson MM, Krishnamoorthy A, Lala A, Lenneman AJ, Lohr NL, Margulies KB, Mentz RJ, Reza N, Wilcox J, Youmans QR, Zieroth S, Teerlink JR. The HFSA Advanced Heart Failure and Transplant Cardiology Fellowship Consensus Conference. J Card Fail 2024; 30:391-398. [PMID: 37806488 DOI: 10.1016/j.cardfail.2023.09.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
There is waning interest among cardiology trainees in pursuing an Advanced Heart Failure/Transplant Cardiology (AHFTC) fellowship as evidenced by fewer applicants in the National Resident Matching Program match to this specialty. This trend has generated considerable attention across the heart failure community. In response, the Heart Failure Society of America convened the AHFTC Fellowship Task Force with a charge to develop strategies to increase the value proposition of an AHFTC fellowship. Subsequently, the HFSA sponsored the AHFTC Fellowship Consensus Conference April 26-27, 2023. Before the conference, interviews of 44 expert stakeholders diverse across geography, site of practice (traditional academic medical center or other centers), specialty/area of expertise, sex, and stage of career were conducted virtually. Based on these interviews, potential solutions to address the declining interest in AHFTC fellowship were categorized into five themes: (1) alternative training pathways, (2) regulatory and compensation, (3) educational improvements, (4) exposure and marketing for pipeline development, and (5) quality of life and mental health. These themes provided structure to the deliberations of the AHFTC Fellowship Consensus Conference. The recommendations from the Consensus Conference were subsequently presented to the HFSA Board of Directors to inform strategic plans and interventions. The HFSA Board of Directors later reviewed and approved submission of this document. The purpose of this communication is to provide the HF community with an update summarizing the processes used and concepts that emerged from the work of the HFSA AHFTC Fellowship Task Force and Consensus Conference.
Collapse
Affiliation(s)
- Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Amrut V Ambardekar
- Department of Medicine, Division of Cardiology; University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathryn Berlacher
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vanessa Blumer
- Inova Schar and Vascular Institute, Falls Church, Virginia
| | - Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard Cheng
- Division of Cardiology, Department of Internal Medicine; University of California San Francisco, San Francisco, California
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - E Wilson Grandin
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eiran Z Gorodeski
- Harrington Heart & Vascular Institute, University Hospitals, and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rachna Kataria
- Department of Cardiology, Lifespan Cardiovascular Institute, Brown University, Providence, Rhode Island
| | - Jason N Katz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute-Cedars Sinai Medical Center, Los Angeles, California
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute & Department of Population Health Science & Policy at Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew J Lenneman
- Division of Cardiovascular Disease; University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole L Lohr
- Division of Cardiovascular Disease; University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane Wilcox
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Quentin R Youmans
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
| |
Collapse
|
4
|
Brown SA, Beavers C, Bauer B, Cheng RK, Berman G, Marshall CH, Guha A, Jain P, Steward A, DeCara JM, Olaye IM, Hansen K, Logan J, Bergom C, Glide-Hurst C, Loh I, Gambril JA, MacLeod J, Maddula R, McGranaghan PJ, Batra A, Campbell C, Hamid A, Gunturkun F, Davis R, Jefferies J, Fradley M, Albert K, Blaes A, Choudhuri I, Ghosh AK, Ryan TD, Ezeoke O, Leedy DJ, Williams W, Roman S, Lehmann L, Sarkar A, Sadler D, Polter E, Ruddy KJ, Bansal N, Yang E, Patel B, Cho D, Bailey A, Addison D, Rao V, Levenson JE, Itchhaporia D, Watson K, Gulati M, Williams K, Lloyd-Jones D, Michos E, Gralow J, Martinez H. Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021. Am Heart J Plus 2024; 38:100354. [PMID: 38510746 PMCID: PMC10945974 DOI: 10.1016/j.ahjo.2023.100354] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 03/22/2024]
Abstract
As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and technology companies. In this report, we summarize proceedings from the first two annual COIN summits (inaugural in 2020 and subsequent in 2021) including educational sessions on technological innovations for establishing best practices and aligning resources. Herein, we highlight emerging areas for innovation and defining unmet needs to further improve the outcome for cancer patients and survivors of all ages. Additionally, we provide actionable suggestions for advancing innovation, collaboration, and education in cardio-oncology in the digital era.
Collapse
Affiliation(s)
- Sherry-Ann Brown
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Craig Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Brenton Bauer
- COR Healthcare Associates, Torrance Memorial Medical Center, Torrance, CA, USA
| | - Richard K. Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Catherine H. Marshall
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Prantesh Jain
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Jeanne M. DeCara
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Iredia M. Olaye
- Division of Clinical Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Jim Logan
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, USA
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Irving Loh
- Ventura Heart Institute, Thousand Oaks, CA, USA
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Alan Gambril
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | | | - Peter J. McGranaghan
- Department of Cardiothoracic Surgery, German Heart Center, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Akshee Batra
- Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Courtney Campbell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Fatma Gunturkun
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John Jefferies
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
- St. Jude Children's Research Hospital, Memphis, TN, USA
- The Heart Institute at Le Bonheur Children's Hospital, University of Tennessee Health and Science Center, Memphis, TN, USA
| | - Michael Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Albert
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Denver, CO, USA
| | - Anne Blaes
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Indrajit Choudhuri
- Department of Electrophysiology, Froedtert South Hospital, Milwaukee, WI, USA
| | - Arjun K. Ghosh
- Cardio-Oncology Service, Barts Heart Centre and University College London Hospital, London, UK
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine; Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ogochukwu Ezeoke
- Department of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Douglas J. Leedy
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Sebastian Roman
- Department of Internal Medicine III: Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lorenz Lehmann
- Department of Internal Medicine III: Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Abdullah Sarkar
- Department of Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Diego Sadler
- Department of Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Elizabeth Polter
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Yang
- Cardio-Oncology Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - David Cho
- Division of Cardiovascular Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alison Bailey
- Center for Heart, Lung, and Vascular Health at Parkridge, HCA Healthcare, Chattanooga, TN, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Vijay Rao
- Indiana Heart Physicians, Franciscan Health, Indianapolis, IN, USA
| | - Joshua E. Levenson
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dipti Itchhaporia
- Cardiology, University of California Irvine, Hoag Hospital Newport Beach, Newport Beach, CA, USA
| | - Karol Watson
- Division of Cardiovascular Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erin Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Hugo Martinez
- St. Jude Children's Research Hospital, Memphis, TN, USA
- The Heart Institute at Le Bonheur Children's Hospital, University of Tennessee Health and Science Center, Memphis, TN, USA
| |
Collapse
|
5
|
Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
Collapse
Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
6
|
Cheng RK, Lee CJ. Ablating Late Cardiovascular Events in Modern Hematopoietic Cell Transplantation: Not There Yet. JACC CardioOncol 2023; 5:833-835. [PMID: 38205006 PMCID: PMC10774746 DOI: 10.1016/j.jaccao.2023.10.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| |
Collapse
|
7
|
Raisi-Estabragh Z, Manisty CH, Cheng RK, Lopez Fernandez T, Mamas MA. Burden and prognostic impact of cardiovascular disease in patients with cancer. Heart 2023; 109:1819-1826. [PMID: 37321830 DOI: 10.1136/heartjnl-2022-321324] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
The number of patients at the intersection of cancer and cardiovascular disease (CVD) is increasing, reflecting ageing global populations, rising burden of shared cardiometabolic risk factors, and improved cancer survival. Many cancer treatments carry a risk of cardiotoxicity. Baseline cardiovascular risk assessment is recommended in all patients with cancer and requires consideration of individual patient risk and the cardiotoxicity profile of proposed anticancer therapies. Patients with pre-existing CVD are potentially at high or very high risk of cancer-therapy related cardiovascular toxicity. The detection of pre-existing CVD should prompt cardiac optimisation and planning of surveillance during cancer treatment. In patients with severe CVD, the risk of certain cancer therapies may be prohibitively high. Such decisions require multidisciplinary discussion with consideration of alternative anti-cancer therapies, risk-benefit assessment, and patient preference. Current practice is primarily guided by expert opinion and data from select clinical cohorts. There is need for development of a stronger evidence base to guide clinical practice in cardio-oncology. The establishment of multicentre international registries and national-level healthcare data linkage projects are important steps towards facilitating enrichment of cardio-oncology research programmes. In this narrative review, we consider epidemiological trends of cancer and CVD comorbidities and the impact of their co-occurrence on clinical outcomes, current approach to supporting cancer patients with pre-existing CVD and gaps in existing knowledge.
Collapse
Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, London, UK
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Charlotte H Manisty
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, London, UK
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Vasbinder A, Zaslavsky O, Heckbert SR, Thompson H, Cheng RK, Saquib N, Wallace R, Haque R, Paskett ED, Reding KW. Associations of Health-Related Quality of Life and Sleep Disturbance With Cardiovascular Disease Risk in Postmenopausal Breast Cancer Survivors. Cancer Nurs 2023; 46:E355-E364. [PMID: 35816026 PMCID: PMC10232669 DOI: 10.1097/ncc.0000000000001133] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer (BC) survivors are at an increased risk of long-term cardiovascular disease (CVD), often attributed to cancer treatment. However, cancer treatment may also negatively impact health-related quality of life (HRQoL), a risk factor of CVD in the general population. OBJECTIVE We examined whether sleep disturbance, and physical or mental HRQoL were associated with CVD risk in BC survivors. METHODS We conducted a longitudinal analysis in the Women's Health Initiative of postmenopausal women given a diagnosis of invasive BC during follow-up through 2010 with no history of CVD before BC. The primary outcome was incident CVD, defined as physician-adjudicated coronary heart disease or stroke, after BC. Physical and mental HRQoL, measured by the Short-Form 36 Physical and Mental Component Summary scores, and sleep disturbance, measured by the Women's Health Initiative Insomnia Rating Scale, were recorded post BC. Time-dependent Cox proportional hazards models were used starting at BC diagnosis until 2010 or censoring and adjusted for relevant confounders. RESULTS In 2884 BC survivors, 157 developed CVD during a median follow-up of 9.5 years. After adjustment, higher Physical Component Summary scores were significantly associated with a lower risk of CVD (hazard ratio, 0.90 [95% confidence interval, 0.81-0.99]; per 5-point increment in Physical Component Summary). No associations with CVD were found for Mental Component Summary or Insomnia Rating Scale. CONCLUSION In BC survivors, poor physical HRQoL is a significant predictor of CVD. IMPLICATIONS FOR PRACTICE Our findings highlight the importance for nurses to assess and promote physical HRQoL as part of a holistic approach to mitigating the risk of CVD in BC survivors.
Collapse
Affiliation(s)
- Alexi Vasbinder
- Author Affiliations: Department of Biobehavioral Nursing and Health Informatics, School of Nursing (Drs Vasbinder, Zaslavsky, Thompson, and Reding); and Department of Epidemiology, School of Public Health (Dr Heckbert), University of Washington, Seattle; Division of Cardiology, Departments of Medicine and Radiology, University of Washington Medical Center (Dr Cheng), Seattle; Research Unit, College of Medicine, Sulaiman Al-Rajhi University (Dr Saquib), Al Bukairiyah, Saudi Arabia; Department of Epidemiology, College of Public Health, University of Iowa (Dr Wallace), Iowa City; Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California & Health Systems Science, Kaiser Permanente School of Medicine (Dr Haque), Pasadena; and Comprehensive Cancer Center and the Department of Medicine, The Ohio State University (Dr Paskett), Columbus
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
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.
Collapse
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.)
| | | | | |
Collapse
|
10
|
Cheng RK, Cuddy SAM. Neurohormonal blockade in transthyretin amyloidosis: perhaps one size does not fit all? Eur Heart J 2023; 44:2908-2910. [PMID: 37224517 DOI: 10.1093/eurheartj/ehad357] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Sarah A M Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02116, USA
| |
Collapse
|
11
|
Leedy DJ, Cuddy SA, Cheng RK. Transthyretin Cardiac Amyloidosis: Underrecognized in the Underrepresented. J Am Heart Assoc 2023; 12:e030802. [PMID: 37486081 PMCID: PMC10492987 DOI: 10.1161/jaha.123.030802] [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] [Indexed: 07/25/2023]
Affiliation(s)
- Douglas J. Leedy
- Division of CardiologyUniversity of Washington Medical CenterSeattleWAUSA
| | | | - Richard K. Cheng
- Division of CardiologyUniversity of Washington Medical CenterSeattleWAUSA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Hamid A, MacLeod J, Erb S, Berman G, Martinez HR, Scherrer-Crosbie M, Cheng RK, Brown SA. Editorial: Leveraging digital and technological innovations in cardio-oncology: building collaborative networks, implementing education and improving the cardiac outcomes of patients. Front Cardiovasc Med 2023; 10:1184988. [PMID: 37180799 PMCID: PMC10169814 DOI: 10.3389/fcvm.2023.1184988] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Affiliation(s)
| | - James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Samuel Erb
- Medical College of Wisconsin, Green Bay, WI, United States
| | | | - Hugo R. Martinez
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Richard K. Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
14
|
Vasbinder A, Cheng RK, Heckbert SR, Thompson H, Zaslavksy O, Chlebowski RT, Shadyab AH, Johnson L, Wactawski-Wende J, Wells G, Yung R, Martin LW, Paskett ED, Reding K. Chronic Oxidative Stress as a Marker of Long-term Radiation-Induced Cardiovascular Outcomes in Breast Cancer. J Cardiovasc Transl Res 2023; 16:403-413. [PMID: 36178659 PMCID: PMC10060433 DOI: 10.1007/s12265-022-10320-2] [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: 04/05/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
While biomarkers have been proposed to identify individuals at risk for radiation-induced cardiovascular disease (RICVD), little is known about long-term associations with cardiac events. We examined associations of biomarkers of oxidative stress (myeloperoxidase, growth differentiation factor-15, 8-hydroxy-2'-deoxyguanosine [8-OH-dG], placental growth factor), cardiac injury (troponin I, cystatin-C), inflammation (interleukin-6, C-reactive protein), and myocardial fibrosis (transforming growth factor-ß) with long-term RICVD in breast cancer (BC) survivors. We conducted a nested case-control study within the Women's Health Initiative of postmenopausal women with incident BC stages I-III, who received radiation and had pre- and post-BC diagnosis serum samples. Cases (n = 55) were defined as developing incident, physician-adjudicated myocardial infarction, coronary heart disease death, other CVD death, heart failure, or stroke after BC. Cases were matched to three controls (n = 158). After adjustment, a higher 8-OH-dG ratio was significantly associated with an elevated long-term risk of RICVD, suggesting oxidative DNA damage may be a putative pathway for RICVD.
Collapse
Affiliation(s)
- Alexi Vasbinder
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Richard K Cheng
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, USA
| | - Susan R Heckbert
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Hilaire Thompson
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Oleg Zaslavksy
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, USA
| | - Lisa Johnson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, USA
| | - Gretchen Wells
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington-Fayette, USA
| | - Rachel Yung
- Division of Medical Oncology, University of Washington, Seattle, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Seattle, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, Department of Medicine, The Ohio State University, Columbus, USA
| | - Kerryn Reding
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA.
| |
Collapse
|
15
|
Kittleson MM, Ruberg FL, Ambardekar AV, Brannagan TH, Cheng RK, Clarke JO, Dember LM, Frantz JG, Hershberger RE, Maurer MS, Nativi-Nicolau J, Sanchorawala V, Sheikh FH. 2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81:1076-1126. [PMID: 36697326 DOI: 10.1016/j.jacc.2022.11.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
16
|
Lin S, Cheng RK. Implications of and potential solutions for the weekend effect in heart transplantation. J Heart Lung Transplant 2023; 42:354-355. [PMID: 36549987 DOI: 10.1016/j.healun.2022.11.010] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Shin Lin
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
| |
Collapse
|
17
|
Ghoneem A, Bhatti AW, Khadke S, Mitchell J, Liu J, Zhang K, Trachtenberg B, Wechalekar A, Cheng RK, Baron SJ, Nohria A, Lenihan D, Ganatra S, Dani SS. Real-World Efficacy of Tafamidis in Patients With Transthyretin Amyloidosis and Heart Failure. Curr Probl Cardiol 2023; 48:101667. [PMID: 36828040 DOI: 10.1016/j.cpcardiol.2023.101667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Tafamidis was associated with a reduction in cardiovascular hospitalizations and all-cause mortality in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) in the ATTR-ACT trial. However, real-world data on the efficacy of tafamidis are limited. We conducted a retrospective, observational cohort study using the TriNetX research network. Patients with wild-type TTR amyloidosis and heart failure (HF) were divided into 2 groups based on treatment with tafamidis. Propensity score matching (PSM) was performed, and rates of heart failure exacerbations (HFE) and all-cause mortality at 12 months were compared. After PSM, 421 patients were in each group (tafamidis vs nontafamidis). During the 12-month follow-up period, patients treated with tafamidis experienced significantly less HFE and all-cause mortality. A higher probability of event-free survival for HFE and all-cause mortality was noted with tafamidis. This real-world analysis supports that tafamidis use is associated with reduced HFE and all-cause mortality in patients with wild-type TTR amyloidosis and HF. Longer-term follow-up is needed to better understand the utility of tafamidis, given the increasing recognition of ATTR-CM and the high cost of tafamidis.
Collapse
Affiliation(s)
| | | | | | | | - Jennifer Liu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen Zhang
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Suzanne J Baron
- Lahey Hospital and Medical Center, Burlington, MA; Baim Institute for Clinical Research, Boston, MA
| | | | | | | | | |
Collapse
|
18
|
Kim Y, Lee Franco R, Lucas AR, Sutton AL, LaRose JG, Kenyon J, Via J, Cheng RK, D’Agostino RB, Sheppard VB, Hundley WG. Prevalence of Cardiovascular Diseases Among Breast Cancer Survivors: Findings From the NHANES 2003-2018. Am J Health Promot 2023; 37:233-238. [PMID: 35975972 PMCID: PMC10981503 DOI: 10.1177/08901171221120910] [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] [Indexed: 01/19/2023]
Abstract
PURPOSE To examine the prevalence of cardiovascular diseases (CVD) among breast cancer (BC) survivors. DESIGN Cross-sectional observational study using the data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. SETTING United States (US). SUBJECTS A nationally representative sample of US women with a history of BC. MEASURES Self-reported CVD status (i.e., coronary artery disease (CAD), heart failure, and stroke) and time of the CVD diagnosis were used to categorize BC survivors into three groups: No CVD, preexisting CVD, and post-acquired CVD after BC diagnosis. ANALYSIS The prevalence of CVD among BC survivors were estimated by demographic characteristics. Complex sampling design of the NHANES was accounted to estimate the population-level prevalence. RESULTS A total of 658 BC survivors were identified, representing 3.01% (≈3.4 million) of the US women aged ≥18 years old. Of those, ≈6% (≈.2 million) had preexisting CVD and ≈11% (≈.4 million) had at least one CVD diagnosed after BC diagnosis, with an average time elapsed ranging from ≈5 years for heart failure to ≈9 years for CAD and stroke. The prevalence of CVD among BC survivors differed by demographic characteristics including age, education, marital status, menopausal, and physical activity levels. CONCLUSION Our findings suggest that BC survivors are at risk of suffering from CVD and public health strategies for the long-term management of CVD risk factors in this vulnerable population group is recommended.
Collapse
Affiliation(s)
- Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - R. Lee Franco
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Alexander R. Lucas
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Arnethea L. Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica G. LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Kenyon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeremy Via
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ralph B. D’Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Vanessa B. Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - W. Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
19
|
Cheng RK, Ky B. The ESC 2022 Cardio-Oncology Guidelines and the Road Ahead in Cardio-Oncology. JACC CardioOncol 2023; 5:131-132. [PMID: 36875902 PMCID: PMC9982291 DOI: 10.1016/j.jaccao.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
20
|
Nazer B, Cheng RK. An Opportunity to Refine Our Understanding of Right Ventricular Involvement in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:S1936-878X(22)00733-1. [PMID: 36881414 DOI: 10.1016/j.jcmg.2022.12.006] [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: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 02/24/2023]
Affiliation(s)
- Babak Nazer
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA. https://twitter.com/B_Naz_MD
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA.
| |
Collapse
|
21
|
Sun LY, Echefu G, Doshi K, Roberts ML, Hamid A, Cheng RK, Olson J, Brown SA. Commentary: "Multimodality advanced cardiovascular and molecular imaging for early detection and monitoring of cancer therapy-associated cardiotoxicity and the role of artificial intelligence and big data". Front Cardiovasc Med 2023; 10:982028. [PMID: 36923958 PMCID: PMC10009261 DOI: 10.3389/fcvm.2023.982028] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/31/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Louise Y Sun
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gift Echefu
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Krishna Doshi
- Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Michelle L Roberts
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Richard K Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Jessica Olson
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
22
|
Akaike T, Cahill K, Akaike G, Huynh ET, Hippe DS, Shinohara MM, Liao J, Apisarnthanarax S, Parvathaneni U, Hall E, Bhatia S, Cheng RK, Nghiem P, Tseng YD. Management and Prognosis of Cardiac Metastatic Merkel Cell Carcinoma: A Case-Control Study and Literature Review. Cancers (Basel) 2022; 14:cancers14235914. [PMID: 36497395 PMCID: PMC9741306 DOI: 10.3390/cancers14235914] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC), an aggressive neuroendocrine skin cancer, has a high rate (20%) of distant metastasis. Within a prospective registry of 582 patients with metastatic MCC (mMCC) diagnosed between 2003-2021, we identified 9 (1.5%) patients who developed cardiac metastatic MCC (mMCC). We compared overall survival (OS) between patients with cardiac and non-cardiac metastases in a matched case-control study. Cardiac metastasis was a late event (median 925 days from initial MCC diagnosis). The right heart was predominantly involved (8 of 9; 89%). Among 7 patients treated with immunotherapy, 6 achieved a complete or partial response of the cardiac lesion. Among these 6 responders, 5 received concurrent cardiac radiotherapy (median 20 Gray) with immunotherapy; 4 of 5 did not have local disease progression or recurrence in the treated cardiac lesion. One-year OS was 44%, which was not significantly different from non-cardiac mMCC patients (45%, p = 0.96). Though it occurs relatively late in the disease course, cardiac mMCC responded to immunotherapy and/or radiotherapy and was not associated with worse prognosis compared to mMCC at other anatomic sites. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer.
Collapse
Affiliation(s)
- Tomoko Akaike
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-221-4594
| | - Kelsey Cahill
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Gensuke Akaike
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
- TRA Medical Imaging, Tacoma, WA 98402, USA
| | - Emily T. Huynh
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Michi M. Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jay Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | | | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | - Evan Hall
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Richard K. Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Yolanda D. Tseng
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| |
Collapse
|
23
|
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
| |
Collapse
|
24
|
Lenihan D, Cheng RK. Early Treatment of Cardiac ATTR. JACC: CardioOncology 2022; 4:455-457. [DOI: 10.1016/j.jaccao.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
25
|
Guha A, Gong Y, DeRemer D, Owusu-Guha J, Dent SF, Cheng RK, Weintraub NL, Agarwal N, Fradley MG. Cardiometabolic Consequences of Targeted Anticancer Therapies. J Cardiovasc Pharmacol 2022; 80:515-521. [PMID: 34654781 PMCID: PMC8977391 DOI: 10.1097/fjc.0000000000001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cardiometabolic disease (CMD) is the most common preventable cause of death in the world. A number of components are included in the spectrum of CMD, such as metabolic syndrome/obesity, hyperglycemia/diabetes, dyslipidemia, and hypertension, which are independently associated with cardiovascular disease risk. These conditions often occur together, and patients with cancer frequently undergo treatments that can generate or worsen CMD. This review highlights and presents mechanistic and epidemiological evidence regarding CMD in 4 categories of anticancer medications, namely, mTOR/PI3K-Akt inhibitors, multitargeted tyrosine kinase inhibitor, immune checkpoint inhibitor therapy, and endocrine therapy. Patients taking these medications need careful monitoring during therapy. There is a role for cardio-oncology and onco-primary care specialists in optimally managing patients at risk to mitigate CMD during treatment with these and other investigational anticancer medications.
Collapse
Affiliation(s)
- Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
- Division of Cardiology, Department of Medicine, Augusta University, Augusta, GA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - David DeRemer
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Susan F Dent
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Richard K Cheng
- Cardiology Division, University of Washington, Seattle, WA, USA
| | - Neal L Weintraub
- Division of Cardiology, Department of Medicine, Augusta University, Augusta, GA
- Vascular Biology Center, Augusta University, Augusta, GA, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, UT, USA
| | - Michael G Fradley
- Division of Cardiology, Department of Medicine, University of Pennsylvania, PA, USA
| |
Collapse
|
26
|
MacLeod J, Abdelrahim M, Painter S, Maddula R, Steward A, Hamid A, Cheng RK, Zaha V, Addison D, Bauer B, Brown SA. Ten step academic-industry digital health collaboration methodology: A case-based guide for digital health research teams with the example of cardio-oncology. Front Cardiovasc Med 2022; 9:982059. [PMID: 36247469 PMCID: PMC9562627 DOI: 10.3389/fcvm.2022.982059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Sabrina Painter
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | | | - Austin Steward
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Richard K. Cheng
- Division of Cardiovascular Medicine, University of Washington, Seattle, WA, United States
| | - Vlad Zaha
- Cardiology Division, University of Texas Southwestern, Dallas, TX, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States
| | - Brenton Bauer
- COR Healthcare Associates, Torrance Memorial Medical Center, Torrance, CA, United States
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Sherry-Ann Brown
| |
Collapse
|
27
|
Brown SA, Berman G, Logan J, Sadler D, Moudgil R, Patel B, Scherrer-Crosbie M, Addison D, Cheng RK, Teske AJ. Leveraging innovation, education, and technology for prevention and health equity: Proceedings from the cardiology oncology innovation ThinkTank 2021. Front Cardiovasc Med 2022; 9:982021. [PMID: 36247476 PMCID: PMC9557098 DOI: 10.3389/fcvm.2022.982021] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Jim Logan
- University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Diego Sadler
- Cardio-Oncology Section, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, FL, United States
| | - Rohit Moudgil
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brijesh Patel
- Section of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV, United States
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, United States
| | - Richard K. Cheng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Arco J. Teske
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
28
|
Perry AS, Mudigonda P, Huang GS, Qureshi B, Cheng RK, Levy WC, Li S. Long-Term Outcomes and Risk Stratification of Patients With Heart Failure With Recovered Ejection Fraction. Am J Cardiol 2022; 173:80-87. [PMID: 35382925 DOI: 10.1016/j.amjcard.2022.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to understand the long-term outcomes of patients with heart failure with recovered ejection fraction, identify predictors of adverse events, and develop a risk stratification model. From an academic healthcare system, we retrospectively identified 133 patients (median age 66, 38% female, 30% ischemic etiology) who had an improvement in left ventricular ejection fraction (LVEF) from <40% to ≥53%. Significant predictors of all-cause mortality, hospitalization, and future reduction in LVEF were identified through Cox regression analysis. Kaplan-Meier survival was 70% at 5 years. Freedom from hospitalization was 58% at 1 year, and the risk of future LVEF reduction to <40% was 28% at 3 years. Diuretic dose and B-type natriuretic peptide (BNP) at the time of LVEF recovery were the strongest predictors of mortality and hospitalization in multivariate-adjusted analysis (BNP hazard ratio 1.13 per 100 pg/ml increase [p <0.01]; furosemide-equivalent dose hazard ratio 1.19 per 40 mg increase [p = 0.02]). An all-cause mortality Cox proportional hazard risk model incorporating New York Heart Association functional class, BNP and diuretic dose at the time of recovery showed excellent risk discrimination (c-statistic 0.79) and calibration. In conclusion, patients with heart failure with recovered ejection fraction have heterogenous clinical outcomes and are not "cured." A risk model using New York Heart Association functional class, BNP, and diuretic dose can accurately stratify mortality risk.
Collapse
|
29
|
Kwan ML, Cheng RK, Iribarren C, Shen H, Laurent CA, Roh JM, Hershman DL, Kushi LH, Greenlee H, Rana JS. Risk of heart failure with preserved versus reduced ejection fraction in women with breast cancer. Breast Cancer Res Treat 2022; 193:669-675. [PMID: 35429322 PMCID: PMC10461432 DOI: 10.1007/s10549-022-06586-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/20/2022] [Accepted: 03/27/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE While clinical heart failure (HF) is recognized as an adverse effect from breast cancer (BC) treatment, sparse data exist on specific HF phenotypes in affected BC survivors. We examined risk of HF by left ventricular ejection fraction (LVEF) status in women with a history of BC. METHODS 14,804 women diagnosed with all stages of invasive BC from 2005 to 2013 and with no history of HF were matched 1:5 to 74,034 women without BC on birth year, race, and ethnicity. LVEF values were extracted from echocardiography studies within 30 days before through 90 days after the HF clinical encounter. HF was stratified into HF with preserved ejection fraction (HFpEF, LVEF ≥ 45%) and HF with reduced ejection fraction (HFrEF, LVEF < 45%). Cumulative incidence rates (CIRs) were estimated with competing risk of overall death. Hazard ratios (HR) were calculated by multivariable Cox proportional hazards regression. RESULTS Mean time to HF diagnosis was 5.31 years (range 0.03-13.03) in cases and 5.25 years (range 0.01-12.94) in controls. 10-year CIRs were 1.2% and 0.9% for overall HF, 0.8% and 0.7% for HFpEF, and 0.4% and 0.2% for HFrEF in cases and controls, respectively. In fully adjusted models, an overall significant increased risk of HF in cases versus controls was observed (HR: 1.31, 95% CI 1.14, 1.51). The increased risk was seen for both HFrEF (HR: 1.59, 95% CI 1.22, 2.08) and HFpEF (HR: 1.22; 95% CI 1.03, 1.45). CONCLUSION BC survivors experienced higher risk of HF compared with women without BC, and the risk persisted across LVEF phenotypes. Systematic cardio-oncology surveillance should be considered to mitigate this risk in BC patients.
Collapse
Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Heather Greenlee
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
30
|
Berardi C, Bluemke DA, Houston BA, Kolb TM, Lima JA, Pezel T, Tedford RJ, Rayner SG, Cheng RK, Leary PJ. Association of soluble Flt-1 with heart failure and cardiac morphology: The MESA angiogenesis study. J Heart Lung Transplant 2022; 41:619-625. [PMID: 35184966 PMCID: PMC9038636 DOI: 10.1016/j.healun.2022.01.003] [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: 08/20/2021] [Revised: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Soluble Fms-like tyrosine kinase 1 (sFlt-1) may inhibit angiogenesis. Higher levels of sFlt-1 are associated with worse prognosis in prevalent heart failure patients. The aim of this study was to better understand the role of sFlt-1 in heart failure pathogenesis by characterizing relationships between sFlt-1, cardiac morphology, and the composite outcome of incident heart failure or cardiovascular (CV) death in in a multiethnic cohort free of CV disease at baseline. METHODS sFlt-1 was measured in 1,381 participants in the Multi-Ethnic Study of Atherosclerosis Angiogenesis sub-study. Linear regression was used to estimate the association between sFlt-1 and cardiac morphology and Cox proportional hazard regression was used to estimate associations with incident heart failure or CV mortality. RESULTS Over a median follow-up of 13.1 years, higher sFlt-1 levels were associated with incident heart failure or CV mortality independent from CV risk factors or NT-proBNP levels (HR 1.17, 95% CI 1.10-1.26, p < 0.001). Higher sFlt-1 levels were also associated with greater baseline left ventricular (LV) mass by cardiac MRI and increased loss of LV mass over the 10 years following the baseline exam (p-value 0.02 for each), but this association was no longer statistically significant after adjustment for baseline NT-proBNP (p = 0.11 and 0.10 respectively). CONCLUSIONS Baseline sFlt-1 levels are associated with incident heart failure and cardiovascular mortality independent of traditional CV risk factors or NT-proBNP. An association was also found with cardiac mass but was no longer significant after adjustment for NT-proBNP.
Collapse
Affiliation(s)
- Cecilia Berardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Brian A Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Todd M Kolb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - João A Lima
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Theo Pezel
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Samuel G Rayner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Peter J Leary
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| |
Collapse
|
31
|
Vuong JT, Stein-Merlob AF, Cheng RK, Yang EH. Novel Therapeutics for Anthracycline Induced Cardiotoxicity. Front Cardiovasc Med 2022; 9:863314. [PMID: 35528842 PMCID: PMC9072636 DOI: 10.3389/fcvm.2022.863314] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 01/04/2023] Open
Abstract
Anthracyclines remain an essential component of the treatment of many hematologic and solid organ malignancies, but has important implications on cardiovascular disease. Anthracycline induced cardiotoxicity (AIC) ranges from asymptomatic LV dysfunction to highly morbid end- stage heart failure. As cancer survivorship improves, the detection and treatment of AIC becomes more crucial to improve patient outcomes. Current treatment modalities for AIC have been largely extrapolated from treatment of conventional heart failure, but developing effective therapies specific to AIC is an area of growing research interest. This review summarizes the current evidence behind the use of neurohormonal agents, dexrazoxane, and resynchronization therapy in AIC, evaluates the clinical outcomes of advanced therapy and heart transplantation in AIC, and explores future horizons for treatment utilizing gene therapy, stem cell therapy, and mechanism-specific targets.
Collapse
Affiliation(s)
- Jacqueline T. Vuong
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Ashley F. Stein-Merlob
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Richard K. Cheng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eric H. Yang
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Eric H. Yang,
| |
Collapse
|
32
|
Reding KW, Simon MS, Cheng RK. Toward a More Precise Understanding of Obesity and Cancer and Cardiovascular Disease Risk. JACC CardioOncol 2022; 4:82-84. [PMID: 35492828 PMCID: PMC9040114 DOI: 10.1016/j.jaccao.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
33
|
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.
Collapse
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
Collapse
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
| |
Collapse
|
34
|
Larson SR, Vasbinder AL, Reding KW, Leary PJ, Branch KR, Shadyab AH, Johnson KC, Haring B, Wallace R, Manson JE, Anderson G, Cheng RK. Histamine H 2 Receptor Antagonists and Heart Failure Risk in Postmenopausal Women: The Women's Health Initiative. J Am Heart Assoc 2022; 11:e024270. [PMID: 35191329 PMCID: PMC9075064 DOI: 10.1161/jaha.121.024270] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prior studies suggested lower risk of heart failure (HF) in individuals taking H2 receptor antagonists (H2RA) compared with H2RA nonusers in relatively small studies. We evaluated the association of H2RA use and incident HF in postmenopausal women in the large‐scale WHI (Women’s Health Initiative) study. Methods and Results This study included postmenopausal women from the WHI without a history of HF at baseline. HF was defined as first incident hospitalization for HF and physician adjudicated. Multivariable Cox proportional hazards regression models evaluated the association of H2RA use as a time‐varying exposure with HF risk, after adjustment for demographic, lifestyle, and medical history variables. Sensitivity analyses examined (1) risk of HF stratified by the ARIC (Atherosclerosis Risk in Communities) score, (2) propensity score matching on H2RA use, (3) use of proton pump inhibitors rather than H2RA nonuse as the referent, and (4) exclusion of those taking diuretics at baseline. The primary analysis included 158 854 women after exclusion criteria, of whom 9757 (6.1%) were H2RA users. During median 8.2 years of follow‐up, 376 H2RA users (4.9 events/1000 person‐years) and 3206 nonusers (2.7 events/1000 person‐years) developed incident HF. After multivariable adjustment, there was no association between H2RA use and HF in the primary analysis (hazard ratio, 1.07; 95% CI, 0.94–1.22; P=0.31) or in any of the sensitivity analyses. Conclusions Clinical H2RA use was not associated with incident HF among postmenopausal women. Future studies are needed to evaluate potential effect modification by sex, HF severity, or patterns of use on H2RA exposure and HF risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000611.
Collapse
Affiliation(s)
- Sophia R Larson
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Alexi L Vasbinder
- Department of Health Informatics School of Nursing University of Washington Seattle WA
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics School of Nursing University of Washington Seattle WA
| | - Peter J Leary
- Division of Pulmonology and Critical Care Medicine Department of Medicine University of Washington Seattle WA
| | - Kelley R Branch
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science University of California, San Diego La Jolla CA
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - Bernhard Haring
- Department of Internal Medicine Saarland University Homburg Germany
| | - Robert Wallace
- Departments of Epidemiology and Medicine University of Iowa Iowa City IA
| | - JoAnn E Manson
- Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Garnet Anderson
- Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle WA
| | - Richard K Cheng
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| |
Collapse
|
35
|
Brown SA, Beavers C, Martinez HR, Marshall CH, Olaye IM, Guha A, Cho D, Bailey A, Bergom C, Bansal N, Bauer B, Cheng RK. Bridging the gap to advance the care of individuals with cancer: collaboration and partnership in the Cardiology Oncology Innovation Network (COIN). Cardiooncology 2022; 8:2. [PMID: 35139920 PMCID: PMC8827263 DOI: 10.1186/s40959-022-00129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/05/2022] [Indexed: 01/21/2023]
Abstract
Cardiovascular diseases and cancer continue to be the two leading causes of death in the United States. While innovations in artificial intelligence, digital health, and telemedicine may revolutionize cardio-oncology clinical practice, barriers to widespread adoption continue to exist. The most effective way to advance these technologies is through a broad range of stakeholders sharing a common vision. Additionally, as we enter the digital era in healthcare, we must help lead this charge for the benefit of our cardiology and oncology patients. Bolstering collaborations in cardiology and oncology is key, in partnership with technology firms, industry, academia, and private practice, with an emphasis on various forms of innovation. The ultimate goal is to connect our patients and their health to informatics-based opportunities to advance cardiovascular disease prevention in cancer patients. We have established the Cardiology Oncology Innovation Network in accordance with this vision, to develop new care delivery options through the use of innovative technological strategies. Our tripartite mission - innovation, collaboration, and education - aims to increase access to and expertise in digital transformation to prevent cardiovascular diseases in cancer patients. Here we describe network initiatives, early accomplishments, and future milestones.
Collapse
Affiliation(s)
- Sherry-Ann Brown
- grid.30760.320000 0001 2111 8460Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Craig Beavers
- grid.266539.d0000 0004 1936 8438University of Kentucky College of Pharmacy, Lexington, KY USA
| | - Hugo R. Martinez
- grid.267301.10000 0004 0386 9246The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health and Science Center, Memphis, TN USA ,grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Catherine H. Marshall
- grid.21107.350000 0001 2171 9311Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Iredia M. Olaye
- grid.5386.8000000041936877XDivision of Clinical Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Avirup Guha
- grid.410427.40000 0001 2284 9329Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA USA
| | - David Cho
- grid.19006.3e0000 0000 9632 6718University of California, Los Angeles, Division of Cardiovascular Medicine, Los Angeles, CA USA
| | - Alison Bailey
- Center for Heart, Lung, and Vascular Health at Parkridge, HCA Healthcare, Chattanooga, TN USA
| | - Carmen Bergom
- grid.4367.60000 0001 2355 7002Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO USA
| | - Neha Bansal
- grid.251993.50000000121791997Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Brenton Bauer
- grid.431038.d0000 0004 0474 1180COR Healthcare Associates, Torrance Memorial Medical Center, Torrance, CA USA
| | - Richard K. Cheng
- grid.34477.330000000122986657Cardio-oncology Program, Division of Cardiology, University of Washington, Seattle, WA USA
| |
Collapse
|
36
|
Kwan ML, Cheng RK, Iribarren C, Neugebauer R, Rana JS, Nguyen-Huynh M, Shi Z, Laurent CA, Lee VS, Roh JM, Shen H, Rillamas-Sun E, Santiago-Torres M, Hershman DL, Kushi LH, Greenlee H. Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study. J Clin Oncol 2022; 40:1635-1646. [PMID: 35025627 PMCID: PMC9113213 DOI: 10.1200/jco.21.01738] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The incidence of cardiometabolic risk factors in breast cancer (BC) survivors has not been well described. Thus, we compared risk of hypertension, diabetes, and dyslipidemia in women with and without BC. METHODS Women with invasive BC diagnosed from 2005 to 2013 at Kaiser Permanente Northern California (KPNC) were identified and matched 1:5 to noncancer controls on birth year, race, and ethnicity. Cumulative incidence rates of hypertension, diabetes, and dyslipidemia were estimated with competing risk of overall death. Subdistribution hazard ratios (sHRs) were estimated by Fine and Gray regression, adjusted for cardiovascular disease-related risk factors, and stratified by treatment and body mass index (BMI). RESULTS A total of 14,942 BC cases and 74,702 matched controls were identified with mean age 61.2 years and 65% non-Hispanic White. Compared with controls, BC cases had higher cumulative incidence rates of hypertension (10.9% v 8.9%) and diabetes (2.1% v 1.7%) after 2 years, with higher diabetes incidence persisting after 10 years (9.3% v 8.8%). In multivariable models, cases had higher risk of diabetes (sHR, 1.16; 95% CI, 1.07 to 1.26) versus controls. Cases treated with chemotherapy (sHR, 1.23; 95% CI, 1.11 to 1.38), left-sided radiation (sHR, 1.29; 95% CI, 1.13 to 1.48), or endocrine therapy (sHR, 1.23; 95% CI, 1.12 to 1.34) continued to have higher diabetes risk. Hypertension risk was higher for cases receiving left-sided radiation (sHR, 1.11; 95% CI, 1.02 to 1.21) or endocrine therapy (sHR, 1.10; 95% CI, 1.03 to 1.16). Normal-weight (BMI < 24.9 kg/m2) cases had higher risks overall and within treatment subgroups versus controls. CONCLUSION BC survivors at KPNC experienced elevated risks of diabetes and hypertension compared with women without BC depending on treatments received and BMI. Future studies should examine strategies for cardiometabolic risk factor prevention in BC survivors.
Collapse
Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, CA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Heather Greenlee
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Borovac JA, Mohamed MO, Kontopantelis E, Alkhouli M, Alraies MC, Cheng RK, Elgendy IY, Velagapudi P, Paul TK, Van Spall HGC, Mamas MA. Frailty Among Patients With Acute ST-Elevation Myocardial Infarction in the United States: The Impact of the Primary Percutaneous Coronary Intervention on In-Hospital Outcomes. J Invasive Cardiol 2022; 34:E55-E64. [PMID: 34982727] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine the average treatment effect (ATE) of primary percutaneous coronary intervention (pPCI) versus medical treatment (MT) on in-hospital outcomes across the spectrum of frailty in patients with ST-elevation myocardial infarction (STEMI). METHODS Adult patients hospitalized for STEMI between October 2015 until December 2017 from the National Inpatient Sample (NIS) database were retrospectively analyzed and stratified by the Hospital Frailty Risk Score into low, intermediate, and high frailty risk subgroups. Propensity score matching analysis was performed to estimate the ATE of pPCI in each frailty subgroup. The primary outcome was all-cause in-hospital death. RESULTS A total of 429,070 patients were included in the final analysis, with 28.4% at an increased frailty risk. Frail patients were significantly less likely to receive pPCI (85.6%, 47.2%, and 22.6% for low, intermediate, and high frailty risk groups). Rates of adverse in-hospital events including death, cerebrovascular event, and major bleeding were significantly higher in patients with increased frailty risk. pPCI was associated with a significant reduction of in-hospital death in low (-8.0%), intermediate (-14.6%), and high (-14.7%) frailty subgroups, compared to MT (P<.001). CONCLUSIONS pPCI was associated with reduced rates of in-hospital death in patients with frailty presenting with STEMI. These findings suggest a benefit of pPCI in this complex patient population, although based on observational data. Long-term effects and safety need to be investigated in future studies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom.
| |
Collapse
|
39
|
Das A, Dasgupta S, Gong Y, Shah UA, Fradley MG, Cheng RK, Roy B, Guha A. Cardiotoxicity as an adverse effect of immunomodulatory drugs and proteasome inhibitors in multiple myeloma: A network meta-analysis of randomized clinical trials. Hematol Oncol 2021; 40:233-242. [PMID: 34940983 DOI: 10.1002/hon.2959] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/04/2021] [Revised: 11/01/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023]
Abstract
We aim to determine the cumulative and comparative risk of cardiovascular events associated with different Immunomodulatory Drugs (iMiDs) and Proteasome Inhibitor (PIs) in Multiple Myeloma (MM) patients through pairwise and network meta-analysis. Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Clinical Trial Registry (Clinical Trials.gov) up to May 2021. Phase 3 randomized clinical trials (RCTs) reporting cardiotoxicity in MM patients (newly diagnoses and/or relapsed) treated with iMiD and/or PI. Studies, where iMiD or PI was used alongside the chemotherapy versus placebo or no additional drugs (control) in the other arm were included. The primary outcome was the presence of cardiotoxicity after follow-up. Pairwise meta-analysis and network meta-analysis were performed using the frequentist's approach to estimate the odds ratio (OR). Twenty RCTs with 10,373 MM patients were included in this analysis. Eleven studies compared iMiDs with control, seven studies compared PIs with control, and two studies compared bortezomib against carfilzomib. CTACE high-grade (≥grade 3) cardiotoxic events were increased with iMiDs compared to their control counterpart (OR 2.05; 95% CI 1.30-3.26). Similar high-grade cardiotoxicity was also noted more frequently with PI use when compared to the control group (OR 1.67; 95% CI 1.17-2.40). Among the PIs, carfilzomib was associated with a maximum risk of cardiotoxicity (OR 2.68; 95% CI 1.63-4.40). There was no evidence of publication bias among studies. iMiDs and PIs, particularly carfilzomib, appear to be associated with increased risk of high-grade cardiovascular events in MM patients.
Collapse
Affiliation(s)
- Avash Das
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Subhajit Dasgupta
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael G Fradley
- Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard K Cheng
- Cardiology Division, University of Washington, Seattle, Washington, USA
| | - Bhaskar Roy
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, UH Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Medicine, Division of Cardiology, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
40
|
Cheng RK, Vasbinder A, Levy WC, Goyal P, Griffin JM, Leedy DJ, Maurer MS. Lack of Association Between Neurohormonal Blockade and Survival in Transthyretin Cardiac Amyloidosis. J Am Heart Assoc 2021; 10:e022859. [PMID: 34729989 PMCID: PMC9075255 DOI: 10.1161/jaha.121.022859] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Despite the belief that heart failure therapies are not effective in transthyretin cardiac amyloidosis, data are limited. We tested the association of neurohormonal blockade use with survival. Methods and Results A total of 309 consecutive patients with transthyretin cardiac amyloidosis were identified. Medication inventory was obtained at baseline and subsequent visits. Exposure included a neurohormonal blockade class (β‐blocker [βB], angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, and mineralocorticoid antagonist) at baseline and subsequent visits. βB was modeled as baseline use, time‐varying use, and in an inverse probability treatment weighted model. Primary outcome was all‐cause mortality analyzed with adjusted Cox proportional hazards models. Continuing compared with stopping βB during follow‐up was tested. Mean age was 73.2 years, 84.1% were men, and 17.2% had atrial fibrillation/flutter at baseline. At the time of study entry, 49.8% were on βBs, 35.0% were on angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and 23.9% were on mineralocorticoid antagonists. For the total cohort, there was a trend toward harm in the unadjusted model for baseline βB use, but this was neutral after adjustment. When βB use was analyzed as a time‐varying exposure, there was no association with mortality. βB discontinuation was associated with decreased mortality for the total cohort. Findings were consistent in inverse probability treatment weighted models. For angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker or mineralocorticoid antagonist use, there was no association with mortality after adjustment for the total cohort. Conclusions There was no association of neurohormonal blockade use with survival in transthyretin cardiac amyloidosis. For the total cohort, deprescribing βB may be associated with improved survival. Additional studies are needed to confirm these findings.
Collapse
Affiliation(s)
| | - Alexi Vasbinder
- Department of Biobehavioral Nursing and Health Informatics University of Washington Seattle WA
| | - Wayne C Levy
- Division of Cardiology University of Washington Seattle WA
| | - Parag Goyal
- Division of Cardiology Division of General Internal Medicine Weill Cornell Medicine New York NY
| | - Jan M Griffin
- Division of Cardiology Columbia University Irving Medical Center New York NY
| | | | - Mathew S Maurer
- Division of Cardiology Columbia University Irving Medical Center New York NY
| |
Collapse
|
41
|
Baker SM, Leedy DJ, Klafter JA, Zhang Y, Secrest KM, Osborn TR, Cheng RK, Judson SD, Merel SE, Mikacenic C, Bhatraju PK, Liles WC. Clinical presentation, complications, and outcomes of hospitalized COVID-19 patients in an academic center with a centralized palliative care consult service. Health Sci Rep 2021; 4:e423. [PMID: 34754946 PMCID: PMC8562312 DOI: 10.1002/hsr2.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/08/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND AIMS Palliative care is a critical component of the response of a healthcare system to a pandemic. We present risk factors associated with mortality and highlight an operational palliative care consult service in facilitating early identification of risk factors to guide goal-concordant care and rational utilization of finite healthcare resources during a pandemic. METHODS In this case series of 100 consecutive patients hospitalized with COVID-19, we analyzed clinical data, treatment including palliative care, and outcomes in patients with SARS-CoV-2 infection admitted to three hospitals in Seattle, Washington. We compared data between patients who were discharged and non-survivors. RESULTS Age (OR 4.67 [1.43, 15.32] ages 65-79; OR 3.96 [1.05, 14.89] ages 80-97), dementia (OR 5.62 [1.60, 19.74]), and transfer from a congregate living facility (OR 5.40 [2.07, 14.07]), as well hypoxemia and tachypnea (OR 7.00 [2.91, 22.41]; OR 2.78 [1.11, 6.97]) were associated with mortality. Forty-one (41%) patients required intensive care and 22 (22%) invasive mechanical ventilation. Forty-six (46%) patients were seen by the palliative care service, resulting in a change of resuscitation status in 54% of admitted patients. Fifty-eight (58%) patients recovered and were discharged, 34 (34%) died, and eight (8%) remained hospitalized, of which seven ultimately survived and one died. CONCLUSIONS Older age, dementia, and congregate living were associated with mortality. Early discussions of goals of care facilitated by an operational palliative care consult service can effectively guide goal-concordant care in patients at high risk for mortality during a pandemic. Development of a functional palliative care consult service is an important component of pandemic planning.
Collapse
Affiliation(s)
- Sarah M. Baker
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Doug J. Leedy
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Jesse Abbott Klafter
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Yilin Zhang
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Tristan R. Osborn
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Richard K. Cheng
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Seth D. Judson
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Susan E. Merel
- Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Carmen Mikacenic
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Pavan K. Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Sepsis Center of Research Excellence‐University of Washington (SCORE‐UW), Department of Medicine, University of WashingtonSeattleWashingtonUSA
| | - W. Conrad Liles
- Sepsis Center of Research Excellence‐University of Washington (SCORE‐UW), Department of Medicine, University of WashingtonSeattleWashingtonUSA
- Division of Allergy and Infectious Disease, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Departments of Global Health, Laboratory Medicine ND Pathology, and PharmacologyUniversity of WashingtonSeattleWashingtonUSA
| |
Collapse
|
42
|
Griffin JM, Rosenthal JL, Grodin JL, Maurer MS, Grogan M, Cheng RK. ATTR Amyloidosis: Current and Emerging Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2021; 3:488-505. [PMID: 34729521 PMCID: PMC8543085 DOI: 10.1016/j.jaccao.2021.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly diagnosed owing to the emergence of noninvasive imaging and improved awareness. Clinical penetrance of pathogenic alleles is not complete and therefore there is a large cohort of asymptomatic transthyretin variant carriers. Screening strategies, monitoring, and treatment of subclinical ATTR-CA requires further study. Perhaps the most important translational triumph has been the development of effective therapies that have emerged from a biological understanding of ATTR-CA pathophysiology. These include recently proven strategies of transthyretin protein stabilization and silencing of transthyretin production. Data on neurohormonal blockade in ATTR-CA are limited, with the primary focus of medical therapy on judicious fluid management. Atrial fibrillation is common and requires anticoagulation owing to the propensity for thrombus formation. Although conduction disease and ventricular arrhythmias frequently occur, little is known regarding optimal management. Finally, aortic stenosis and ATTR-CA frequently coexist, and transcatheter valve replacement is the preferred treatment approach.
Collapse
Key Words
- 6MWT, 6-minute walk test
- AF, atrial fibrillation
- AL, light chain amyloid
- AS, aortic stenosis
- ASO, antisense oligonucleotide
- ATTR-CA, transthyretin cardiac amyloidosis
- ATTRv, variant transthyretin cardiac amyloidosis
- ATTRwt, wild-type transthyretin cardiac amyloidosis
- CMR, cardiac magnetic resonance
- DCCV, direct current cardioversion
- HF, heart failure
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- SAP, serum amyloid P component
- TAVR, transcatheter aortic valve replacement
- amyloidosis
- cardiomyopathy
- heart failure
- siRNA, small interfering RNA
Collapse
Affiliation(s)
- Jan M Griffin
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mathew S Maurer
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Richard K Cheng
- University of Washington Medical Center, Seattle, Washington, USA
| |
Collapse
|
43
|
Kobo O, Khattak S, Lopez-Mattei J, Van Spall HGC, Graham M, Cheng RK, Osman M, Sun L, Ullah W, Fischman DL, Roguin A, Mohamed MO, Mamas MA. Trends in cardiovascular mortality of cancer patients in the US over two decades 1999-2019. Int J Clin Pract 2021; 75:e14841. [PMID: 34514707 DOI: 10.1111/ijcp.14841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cancer is the second most common cause of death globally after cardiovascular disease, and cancer patients are at an increased risk of CV death. This recognition has led to publication of cardio-oncological guidelines and to the widespread adoption of dedicated cardio-oncology services in many institutes. However, it is unclear whether there has been a change in the incidence of CV death in cancer patients. METHODS AND RESULTS Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset, we determined national trends in age-standardised mortality rates attributed to cardiovascular diseases in patients with and without cancer, from 1999 to 2019, stratified by cancer type, age, gender, race, and place of residence (state and urbanisation status). Among more than 17.8 million cardiovascular deaths in the United States, 13.6% were patients with a concomitant cancer diagnosis. During the study period, among patients with cancer, the age-adjusted mortality rate dropped by 52% (vs 38% in patients with no cancer). In cancer patients, age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with haematological malignancy (59%-63% vs. 41%). Similar reduction was observed in both genders (53%-54%), but more prominent reduction was observed in older patients and in those living in metro areas. CONCLUSIONS Our findings emphasise the role of multidisciplinary management of cancer patients. Widespread adoption of cardio oncology services have the potential to impact the inherent risk of increased CV mortality in both cancer patients and survivors.
Collapse
Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Sophia Khattak
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michelle Graham
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard K Cheng
- Division of Cardiology, University of Washington Heart Institute, Seattle, Washington, USA
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David L Fischman
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Institute of Population Health, University of Manchester, Manchester, UK
| |
Collapse
|
44
|
Kobo O, Brown SA, Nafee T, Mohamed MO, Sharma K, Istanbuly S, Roguin A, Cheng RK, Mamas MA. Impact of malignancy on In-hospital mortality, stratified by the cause of admission: An analysis of 67 million patients from the National Inpatient Sample. Int J Clin Pract 2021; 75:e14758. [PMID: 34490963 PMCID: PMC8983059 DOI: 10.1111/ijcp.14758] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the patient characteristics and the reason for admission of patients with malignancy by malignancy, and to study mortality rates for the different causes of admissions among the different types of cancer. PATIENTS AND METHODS Using the nationwide Inpatient Sampling (2015-2017) we examined the cause of admission and associated in-hospital mortality, stratified by presence and type of malignancy. Multivariable logistic regression models were used to examine the association between in-hospital mortality and malignancy sites for different primary admission causes. RESULTS Out of 67 819 693 inpatient admissions, 8.8% had malignancy. Amongst those with malignancy, haematological malignancy was the most common (20.2%). The most common cause of admission amongst all cancers were malignancy-related admissions, where up to 57% of all colorectal admissions were malignancy-related. The most common non-malignancy cause of admission was infectious causes, which were most frequent among patients with haematological malignancy (18.4%). Patients with malignancy had higher crude mortality rates (5.7% vs 1.9%). Mortality rates were highest among patients with lung cancer (8.7%). Among all admissions, the adjusted rates of mortality were higher for patients with lung (OR 3.65, 95% CI [3.59-3.71]), breast (OR 2.06, 95% CI [1.99-2.13]), haematological (OR 1.79, 95% CI [1.76-1.82]) and colorectal (OR 1.71, 95% CI [1.66-1.76]) malignancies compared with patients with no malignancy. CONCLUSION Our work highlights the need to consider the burden of cancer on our hospital services and consider how the prognostic impact of different types of admissions may relate to the type of cancer diagnosis and understand whether these differences relate to disparities in clinical care/treatments.
Collapse
Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tarek Nafee
- Department of Medicine, Roger Williams Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Mohamed O. Mohamed
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom
| | - Kamal Sharma
- U.N. Mehta ICRC, B. J. Medical College, Ahmedabad, India
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom
| | - Richard K. Cheng
- Division of Cardiology, University of Washington Heart Institute, Seattle, WA, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
45
|
Cheng RK, Maurer MS. Recognition and Implications of Undiagnosed Cardiac Amyloid Patients in HFpEF Trials. JACC Heart Fail 2021; 9:803-806. [PMID: 34509407 DOI: 10.1016/j.jchf.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| |
Collapse
|
46
|
Affiliation(s)
- Dennis D. Wang
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Richard K. Cheng
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rong Tian
- Mitochondria and Metabolism Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
47
|
Fradley MG, Beckie TM, Brown SA, Cheng RK, Dent SF, Nohria A, Patton KK, Singh JP, Olshansky B. Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e41-e55. [PMID: 34134525 DOI: 10.1161/cir.0000000000000986] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
With the advent of novel cancer therapeutics and improved screening, more patients are surviving a cancer diagnosis or living longer with advanced disease. Many of these treatments have associated cardiovascular toxicities that can manifest in both an acute and a delayed fashion. Arrhythmias are an increasingly identified complication with unique management challenges in the cancer population. The purpose of this scientific statement is to summarize the current state of knowledge regarding arrhythmia identification and treatment in patients with cancer. Atrial tachyarrhythmias, particularly atrial fibrillation, are most common, but ventricular arrhythmias, including those related to treatment-induced QT prolongation, and bradyarrhythmias can also occur. Despite increased recognition, dedicated prospective studies evaluating true incidence are lacking. Moreover, few studies have addressed appropriate prevention and treatment strategies. As such, this scientific statement serves to mobilize the cardio-oncology, electrophysiology, and oncology communities to develop clinical and scientific collaborations that will improve the care of patients with cancer who have arrhythmias.
Collapse
|
48
|
Schlam I, Lee AY, Li S, Sheikh FH, Zaghlol R, Basyal B, Gallagher C, Molina E, Mahr C, Cheng RK, Barac A. Left Ventricular Assist Devices in Patients With Active Malignancies. JACC CardioOncol 2021; 3:305-315. [PMID: 34396339 PMCID: PMC8352017 DOI: 10.1016/j.jaccao.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/14/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy. OBJECTIVES The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs. METHODS In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 3:1 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators. RESULTS Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI]: 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI: 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio: 2.05; 95% CI: 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different. CONCLUSIONS Our study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.
Collapse
Affiliation(s)
- Ilana Schlam
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Andy Y. Lee
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Song Li
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Farooq H. Sheikh
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Raja Zaghlol
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Binaya Basyal
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Christopher Gallagher
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Claudius Mahr
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Richard K. Cheng
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| |
Collapse
|
49
|
Schueler S, Silvestry SC, Cotts WG, Slaughter MS, Levy WC, Cheng RK, Beckman JA, Villinger J, Ismyrloglou E, Tsintzos SI, Mahr C. Cost-effectiveness of left ventricular assist devices as destination therapy in the United Kingdom. ESC Heart Fail 2021; 8:3049-3057. [PMID: 34047072 PMCID: PMC8318455 DOI: 10.1002/ehf2.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/05/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023] Open
Abstract
Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.
Collapse
Affiliation(s)
| | - Scott C Silvestry
- Cardiothoracic Surgery, Advent Health Transplant Institute, Orlando, FL, USA
| | - William G Cotts
- Heart Transplantation and Mechanical Assistance, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Mark S Slaughter
- Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Wayne C Levy
- Cardiology, University of Washington, Seattle, WA, USA
| | | | | | - Jonas Villinger
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | | | - Claudius Mahr
- Cardiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
50
|
Chatterjee NA, Jensen PN, Harris AW, Nguyen DD, Huang HD, Cheng RK, Savla JJ, Larsen TR, Gomez JMD, Du-Fay-de-Lavallaz JM, Lemaitre RN, McKnight B, Gharib SA, Sotoodehnia N. Admission respiratory status predicts mortality in COVID-19. Influenza Other Respir Viruses 2021; 15:569-572. [PMID: 34028169 PMCID: PMC8242415 DOI: 10.1111/irv.12869] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has significant case fatality. Glucocorticoids are the only treatment shown to improve survival, but only among patients requiring supplemental oxygen. WHO advises patients to seek medical care for "trouble breathing," but hypoxemic patients frequently have no respiratory symptoms. Our cohort study of hospitalized COVID-19 patients shows that respiratory symptoms are uncommon and not associated with mortality. By contrast, objective signs of respiratory compromise-oxygen saturation and respiratory rate-are associated with markedly elevated mortality. Our findings support expanding guidelines to include at-home assessment of oxygen saturation and respiratory rate in order to expedite life-saving treatments patients to high-risk COVID-19 patients.
Collapse
Affiliation(s)
| | - Paul N Jensen
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Andrew W Harris
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Daniel D Nguyen
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Jainy J Savla
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Timothy R Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Barbara McKnight
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Sina A Gharib
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Nona Sotoodehnia
- Division of Cardiology, University of Washington, Seattle, WA, USA.,Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| |
Collapse
|