肿瘤心脏病学:交叉学科的机遇与挑战

心血管疾病与肿瘤均位列慢性非传染性疾病的前3位,随着肿瘤诊疗技术的发展,患者生存期明显延长,合并心血管疾病的比例明显升高,此外抗肿瘤治疗带来的心血管损伤又促使心血管事件发生率明显升高,引发了抗肿瘤治疗心血管安全性评价的争议与反思。肿瘤治疗与心血管疾病进入交汇时代,肿瘤心脏病这一新生交叉学科应运而生。该文就抗肿瘤治疗诱导心血管疾病尤其是心力衰竭等心脏毒性的损伤机制、风险评估以及防治管理的最新研究进展进行了梳理与总结。     

老年心血管疾病与抗肿瘤药物北大核心CSCD

心血管疾病和恶性肿瘤是威胁人类健康的两类主要疾病,心血管疾病合并恶性肿瘤的临床情境在老年患者中愈发常见。随着肿瘤治疗技术的飞速进步,肿瘤患者预后明显改善的同时,很多肿瘤患者发生心血管事件甚至死亡,而肿瘤治疗相关的心血管毒性被认为是一项很重要的影响因素。如何在抗肿瘤治疗获益的基础上减少或避免相关的心血管毒性,是所有肿瘤科医生和心血管病医生共同面临的挑战。文章就抗肿瘤药物的心血管毒性、抗肿瘤药物心血管毒性监测与防治以及抗肿瘤药物与心血管药物的相互作用进行总结,并指出抗肿瘤药物心血管毒性的防治重点在于风险评估、提前预警、优化治疗方案并及早识别不良反应。     

心血管疾病危险因素对肿瘤的作用

近年来,心血管疾病及肿瘤已成为全球发病率和病死率最高的两种疾病。随着肿瘤心脏病学这一新兴交叉学科的产生,关于心血管疾病危险因素对肿瘤作用方面的研究也逐渐为大家所关注。心血管疾病危险因素根据其是否可控制通常分为可变的危险因素及不可变的危险因素。现就心血管疾病危险因素对肿瘤的作用及现有研究机制做一阐述,以进一步深入了解心血管疾病及肿瘤存在一定的内在联系,有助于进行疾病的预防及治疗。     

《2016年欧洲心脏病学会肿瘤治疗与心血管毒性声明》解读

<正>心血管疾病与肿瘤是全球负担最大的两个慢性疾病。近年研究表明,心血管疾病-肿瘤的研究焦点已从对单一疾病的预防和治疗转为对两者之间潜在关系的探讨[1]。肿瘤和心血管疾病常伴有共同的危险因素,肿瘤患者生存时限的延长造成了心血管疾病发病率和死亡率的升高;同时肿瘤的化学和放射治疗相关的心血管毒性也是关注的重点。鉴于肿瘤患者的特殊性,产生了新兴的交叉学科——肿瘤心脏病学。2016年8月28日欧洲心脏病学会     

读隔行科学家的意见,茅塞顿开

Markwald是美国南卡罗林那医学院的心血管发育中心主任，细胞生物学和解剖学会主席。他从自己的专业出发，预见心血管发育学的下一个前沿是用整合的队伍，整合的思维解决成人的心血管疾病问题。因为发育生物学的许多知识和研究成果有助于与临床心血管学专家对疾病的病理生理解释，有助于疾病的诊断和治疗。他呼吁两个领域更加密切合作。     

《中华老年多器官疾病杂志》诚征广告

《中华老年多器官疾病杂志》是由中国人民解放军总医院主管、中国人民解放军总医院老年心血管病研究所和中国科技出版传媒股份有限公司主办、国内外公开发行的医学学术期刊,主要交流老年心血管疾病,尤其是老年心血管疾病合并其他疾病、老年两个以上器官疾病以及其他老年多发疾病的诊治经验与教训。刊登内容包括心血管系统、呼吸系统、神经系统、内分泌系统、。肾脏系统、消化系统、骨骼系统等各个方面疾病,涉及临床和基础研究等诸多领域,为从事老年医学及其相关疾病专业的医疗、科研及教学人员必读的刊物。     

冠心病的预防及治疗——专访中国医科大学第一临床学院心血管内科曾定尹教授

近年来，冠心病在我国的发病率和死亡率呈迅速上升趋势，是我国居民死因构成中上升最快的疾病，已成为威胁公众健康的重要疾病。近日，我们非常荣幸地采访到中国医科大学附属第一医院心血管内科曾定尹教授。曾教授从事心血管疾病的临床预防及治疗已40多年，有着丰富的临床工作经验。在此，曾教授就有关心血管疾病，尤其是冠心病的预防及治疗，给出了针对性的建议。     

围堵心血管危险因素,预防心血管急性事件

目前,心血管疾病已成为威胁人类健康的首要疾病.其主要危害是急性事件发生率高,50%以上的患者其首次事件发生就表现为急性心肌梗死或猝死.心血管病导致的死亡已经占所有原因死亡的三分之一,分别超过了肿瘤、传染性疾病、意外灾害等引起的死亡数.     

没有标准可改变心血管危险因素的冠状动脉疾病人群研究进展

标准可改变心血管危险因素（SMuRFs）是指吸烟状况、高血压、糖尿病和高胆固醇血症。识别和管理SMuRFs可很大程度改善心血管疾病的预后。目前心血管疾病仍然是全球死亡的主要原因。最近的研究发现没有标准可改变心血管危险因素（SMuRFs-less）在冠状动脉疾病人群中普遍存在，且比例逐年增加。SMuRFs-less的冠状动脉疾病患者在临床很容易受到忽视。近期研究表明SMuRFs-less相比SMuRFs的冠状动脉患者有更高的全因死亡率和心血管死亡率。因此，早期识别以及诊治这部分患者至关重要。本文就目前SMuRFs-less在冠状动脉疾病中的研究进展进行综述，以增加对SMuRFs-less的认识，更好地为SMuRFs-less人群提供综合全面的评估和管理。     

蛋白质组学在人类疾病研究中的应用

蛋白质组学是后基因组时代生命科学研究的热点和前沿领域,应用蛋白质组学对临床疾病进行研究,不仅从蛋白质水平上揭示疾病的本质,还有助于全面探讨其病理生理机制,寻找诊断和预后标志物,发现药物治疗靶点。目前蛋白质组学广泛用于肿瘤、心血管疾病和肾脏疾病等领域。     

Preparing the Cardiovascular Workforce to Care for Oncology Patients: JACC Review Topic of the Week

Cardiovascular disease and cancer are the 2 main causes of death in the United States. They intersect on multiple levels, sharing common causal mechanisms and epidemiological risk factors. The growing prevalence and complexity of cardiovascular disease and cancer have resulted in the development of the discipline of cardio-oncology. Preparing the cardiovascular workforce for the care of a growing population of cancer patients is necessary to enhance the delivery of high-quality cardiovascular care for patients with cancer. The goal of this review is to present the dedicated efforts of the cardio-oncology community to meet the growing need for education and training of cardiovascular practitioners providing care to cancer patients and survivors. Integration in general cardiology training programs and the efforts of the stakeholder organizations serve as an example of how a multidimensional, innovative approach can address provider education and training needs in a relatively new discipline.     

Update on cardio-oncology: Novel cancer therapeutics and associated cardiotoxicities

There have been significant advances in the field of oncology leading to improved survival as a result of novel targeted and immunotherapies. Despite these improved outcomes, there is increased recognition of cardiotoxicities associated with these therapies that can lead to significant morbidity and mortality. As such, the field of cardio-oncology has seen significant growth over the last several years. In this review, we discuss recent advances in the field of cardio-oncology and provide a detailed discussion of the cardiovascular complications associated with novel cancer therapeutics including tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, CDK4/6 inhibitors and immunotherapies.     

Cardioprotective strategies to prevent breast cancer therapy-induced cardiotoxicity

Breast cancer is the most common malignancy affecting females, with over 260,000 new cases annually and over 3.1 million survivors in the United States alone. Exposure to potentially cardiotoxic therapies, including anthracyclines, trastuzumab, and radiation therapy, coupled with host factors, place patients at increased risk for the development of cardiovascular disease (CVD) compared to non-cancer controls. Overall survival outcomes are significantly worse in patients who develop CVD, and in certain breast cancer populations, cardiovascular death exceeds the risk of cancer death in the long-term. In order to mitigate the risk of CVD, there is a growing interest in the use of cardioprotective strategies at the time of cancer therapy initiation. In this review, we present a detailed evaluation of the evidence from recently completed as well as ongoing cardio-oncology clinical trials in pharmacologic cardioprotection in breast cancer patients. We focus primarily on the potential role of dexrazoxane, alterations in anthracycline dosing or formulation, neurohormonal antagonists, beta-blockers, and combination therapy. We also discuss ongoing studies in statin cardioprotection, radiation delivery strategies, use of risk-guided strategies and the study of specific cancer populations. We close with a discussion of the ongoing needs in the field of cardio-oncology in order to advance the clinical care of patients with rigorous, evidence-based medicine.     

Clinical experience of a cardio-oncology consultation at a tertiary university hospital in Portugal: An observational study

IntroductionHeart disease and cancer are the two leading causes of morbidity and mortality worldwide. Advances in cancer screening and management have led to longer survival and better quality of life. Despite this progress, many cancer patients experience cardiovascular complications during and after cancer treatment. This study describes the experience of a cardio-oncology program at tertiary academic hospital.MethodsIn this retrospective observational study, cancer patients referred to the CHULN cardio-oncology consultation (COC) between January 2016 and December of 2019 were included. Data collected included: patient demographics, cancer type, reason for referral, cardiovascular risk factors, cardiac and oncologic treatments and clinical outcomes.ResultsA total of 520 patients (mean age: 65 ± 14 years; 65% women) were referred to the COC. The main reasons for referral were suspected heart failure (26%), pre-high risk chemotherapy assessment (20%) and decreased LVEF (15%). Pre-existing cardiovascular risk factors were common (79%) and 309 (59%) were taking cardiac medications. The most common type of malignancy was breast cancer (216, 41%) followed by gastrointestinal (139, 27%). More than half received anthracycline-based regimens (303, 58%). Most patients (401; 77%) successfully completed cancer therapy. At the time of last data collection, the majority of patients were alive (430, 83%). Cardiac-related mortality was observed in 16%.ConclusionsThe close collaboration between cardiology and oncology teams and timely cardiac monitoring was the key to the majority of patients to completing their prescribed cancer therapy.     

The Future of Cardiac Magnetic Resonance Clinical Trials

Over the past 2 decades, cardiac magnetic resonance (CMR) has become an essential component of cardiovascular clinical care and contributed to imaging-guided diagnosis and management of coronary artery disease, cardiomyopathy, congenital heart disease, cardio-oncology, valvular, and vascular disease, amongst others. The widespread availability, safety, and capability of CMR to provide corresponding anatomical, physiological, and functional data in 1 imaging session can improve the design and conduct of clinical trials through both a reduction of sample size and provision of important mechanistic data that may augment clinical trial findings. Moreover, prospective imaging-guided strategies using CMR can enhance safety, efficacy, and cost-effectiveness of cardiovascular pathways in clinical practice around the world. As the future of large-scale clinical trial design evolves to integrate personalized medicine, cost-effectiveness, and mechanistic insights of novel therapies, the integration of CMR will continue to play a critical role. In this document, the attributes, limitations, and challenges of CMR’s integration into the future design and conduct of clinical trials will also be covered, and recommendations for trialists will be explored. Several prominent examples of clinical trials that test the efficacy of CMR-imaging guided pathways will also be discussed.     

Cardio-oncology and transplantation for acute myeloid leukemia

Despite the rapidly evolving treatment landscape for acute myeloid leukemia (AML), allogeneic hematopoietic cell transplantation (allo-HCT) remains an important and potentially curative treatment option for many high-risk AML patients. Cardiovascular disease is an important competing risk throughout allo-HCT and a key driver of morbidity and mortality long after treatment. Cardio-oncology is a new discipline in cardiology which provides multidisciplinary care and expertise to complex cancer patients with the aims of optimizing cardiovascular health plus monitoring and treating potential cardiotoxicity related to cancer treatments. As allogeneic HCT techniques get more sophisticated there will be an increase in transplant eligible older patients with a rise in comorbidities including established cardiovascular disease highlighting the need for close collaboration with cardio-oncology specialists from the time of diagnosis through late survivorship.     

Câncer e Doenças Cardiovasculares na Pandemia de COVID-19

The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients’ needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.     

An update on cardio-oncology

Over the past decades, there have been great advancements in the survival outcome of patients with cancer. As a consequence, treatment regimens are being extended to patient populations that would not have qualified in the past based on comorbidities and age. Furthermore, the anti-cancer regimens, which have been and are being used, can cause considerable morbidity and even mortality. In fact, new drugs such as tyrosine kinase inhibitors have yielded unanticipated side effects in frequency and severity. The cardiovascular disease spectrum is an important element in all of these. In order to optimize the outcome of cancer patients with cardiovascular diseases existing prior to cancer treatment or developing as a consequence of it, a new discipline called “cardio-oncology” has evolved over the past few years. Herein, we review the latest developments in this field including cardiotoxicities, vascular toxicities, and arrhythmias. This field is taking on more shape as cardiologists, oncologists, and hematologists are forming alliances, programs, and clinics, supported by the development of expert consensus statements on best management approaches and care of the cancer patient with cardiovascular diseases.     

Prevention of Cardiotoxicities With Traditional and Novel Chemotherapeutic Agents

Purpose of Review

This review will discuss strategies to prevent cardiotoxicity associated with chemotherapeutics. Forty years ago, investigators identified dose-dependent cardiotoxicity related to anthracycline-based regimens. Over recent decades, the development of more selective, mechanism-based chemotherapeutics has been associated with both on-target and off-target adverse cardiovascular sequelae.

Recent Findings

Strategies to prevent or attenuate cardiotoxicities include limitation of anthracycline dose, appropriate patient selection, referral/access to cardio-oncology programs, early recognition of cardiac side effects, active cardio-surveillance, cardio-protective medical therapy, treatment-specific concerns, and follow-up. The importance of accurate diagnosis of cardiotoxicity is important as false-positive testing may result in inappropriate holding or stopping potentially life-saving chemotherapy. Data to support use of cardio-protective medical therapy to prevent chemotherapy-related cardiotoxicity is modest at best, limited by marginal effect size, small patient numbers, and short follow-up.

Summary

The rapid growth in cardio-oncology clinics may facilitate larger multi-center randomized controlled trials in this area.

     

La relación bidireccional entre el cáncer y la ateroesclerosis

In the last few years, there has been growing interest in the relationship between cancer and cardiovascular disease. The increase in life expectancy in both diseases has led to their frequent coexistence in the same patient, which can lead to adverse drug reactions that increase patient risk. This is especially relevant in the case of atherosclerosis, which seems to share a common pathophysiological substrate with cancer. In this review, we analyze these common risk factors, and specifically analyze the relationship between different cancer treatments with the risk of coronary or cerebrovascular disease, as well as the current scientific evidence on the possible relationship between antiplatelet therapy and cancer risk. We also review the incidence and prognosis of cancer in patients with atherosclerosis and vice versa, based on the information reported in the most recently published studies in the field of cardio-oncology.