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Cancer and Heart Failure

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Cancer and heart failure…heart failure and cancer. One can cause the other and common cancer therapies can cause heart failure. So what’s a survivor of either/or/both cancer and heart failure to do?

I try to link research in each blog post on PeopleBeatingCancer but medical doctors are lousy writers.

“Despite advances in understanding the interplay between immune system dysregulation, tissue inflammation, and oxidative stress in cancer-induced cardiac dysfunction, clinical recognition and systematic investigation of these phenomena remain limited…”

I’m pretty sure that the sentence pasted above says that while medicine is trying to learn about the interplay of cancer and heart failure, there is little recognition of the relationship between the two  and even less research into the issue.

To me, a long-term cancer survivor who has chemotherapy-induced cardiomyopathy, the sentence means that conventional medicine has little to offer me in terms of research or actual therapies that can help me.


What is the interplay between cancer and heart failure?

1. Direct Impact of Cancer on the Heart

  • Tumor Invasion: Certain cancers, such as lung and breast cancer, can directly invade cardiac structures, leading to mechanical obstruction or impaired function of the heart.
  • Metastasis: Cancer metastasis to the heart, although relatively rare, can cause pericardial effusion, myocardial infiltration, or even obstructive masses within cardiac chambers.

2. Indirect Effects of Cancer on the Heart

  • Paraneoplastic Syndromes: Some cancers can lead to paraneoplastic syndromes that affect the heart. For example, small cell lung cancer can produce anti-Hu antibodies that result in a variety of cardiac issues.
  • Inflammation and Coagulopathy: Cancer is often associated with a pro-inflammatory state and a hypercoagulable state, both of which can contribute to cardiovascular complications such as myocardial infarction or stroke.

3. Impact of Cancer Treatments on Heart Failure

  • Chemotherapy: Many chemotherapeutic agents are cardiotoxic. For example, anthracyclines (like doxorubicin) are well-known for causing dose-dependent cardiomyopathy, which can progress to heart failure. Other agents such as trastuzumab, a monoclonal antibody used in breast cancer, can also lead to heart failure, especially when combined with anthracyclines.
  • Radiation Therapy: Radiation to the chest can lead to long-term damage to cardiac tissues, including the myocardium, coronary arteries, and valves, resulting in conditions such as coronary artery disease, valvular disease, and restrictive cardiomyopathy.
  • Targeted Therapies and Immunotherapy: Newer treatments, including tyrosine kinase inhibitors and immune checkpoint inhibitors, have been associated with cardiovascular side effects, including myocarditis, hypertension, and heart failure.

4. Shared Risk Factors

  • Lifestyle Factors: Common risk factors for both cancer and heart disease include smoking, obesity, sedentary lifestyle, and poor diet. These shared risk factors can exacerbate the likelihood of both conditions occurring concurrently.
  • Age: The risk of both cancer and heart failure increases with age, making older adults more susceptible to the interplay between these diseases.

5. Biological Mechanisms

  • Genetic and Molecular Pathways: There are shared genetic and molecular pathways that contribute to both cancer and heart disease. For instance, oxidative stress and chronic inflammation are common processes that can lead to both tumor development and cardiovascular disease.
  • Metabolic Dysregulation: Dysregulation in metabolic pathways, such as those involving glucose and lipid metabolism, can contribute to both cancer progression and heart failure.

6. Clinical Implications

  • Diagnosis and Monitoring: Patients with cancer need to be carefully monitored for signs of cardiac dysfunction, particularly if they are receiving potentially cardiotoxic treatments. Echocardiography, cardiac biomarkers (like troponins and BNP), and advanced imaging techniques (such as cardiac MRI) are often used.
  • Management Strategies: Management of patients with both cancer and heart failure requires a multidisciplinary approach. Cardiologists and oncologists need to work together to optimize treatment plans that minimize cardiac risk while effectively treating cancer. This might include the use of cardioprotective agents (like beta-blockers and ACE inhibitors) and modifying cancer treatment regimens to reduce cardiotoxicity.

7. Patient Outcomes

  • Prognosis: The presence of heart failure in a cancer patient generally worsens the prognosis due to the additive effects of both conditions on overall health. The management of heart failure can be challenging in cancer patients due to potential interactions between heart failure medications and cancer treatments, as well as the overall frailty of the patient.

man hand holding his nutritional supplemets, healthy lifestyle background.

The answer then, is to continue what I’m doing to reduce my risk of

  • cancer,
  • treatment-induced secondary cancer
  • treatment-induced heart failure
  • treatment-induced long-term and late stage side effects.

The content linked below is important. It is not simply cardiotoxic chemo that cancer patients need to look out for. It really is a full spectrum approach that is needed to understand cancer and heart failure.

Heart healthy nutrition, supplementation, moderate exercise, all are my go-to therapies. Yes, cardiology has many effective meds to offer the heart failure patient. Though I believe that our first step is nutrition, supplementation, etc.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Cancer as an Individual Risk Factor for Heart Failure: A Review of Literature

“Abstract- The intricate relationship between cancer and cardiovascular diseases (CVD), notably heart failure (HF), is gaining attention in the medical field. This literature review explores the intricate interplay between cancer and CVD, particularly HF, emphasizing their significant impact on global mortality and comorbidity.

While preventive measures have contributed to reducing their incidence, challenges persist in predicting and managing cancer-related complications. This review article delves into various risk factors associated with both cancer and HF, including lifestyle factors, genetic predispositions, and immune system dysregulation.

It highlights emerging evidence suggesting a direct interaction between cancer and HF, with studies indicating an elevated risk of mortality from cancer in patients with HF and vice versa.

Pathological mechanisms such as inflammation, oxidative stress, and tissue hypoxia are implicated in cancer-induced cardiac dysfunction, underscoring the need for comprehensive clinical investigations and ethical considerations in patient care.

The review also discusses the potential role of biomarkers in risk assessment, early detection of cardiotoxicity, and understanding common pathophysiological links between cancer and HF, paving the way for multifaceted preventive and therapeutic approaches…

Stoltzfus et al. described a study amongst 7.5 million cancer patients and identified that those who were diagnosed <40 years of age were more likely to die of heart disease when diagnosed with

  • breast cancer or
  • lymphoma;

patients diagnosed >40 years of age were more likely to die from heart disease when diagnosed with

  • prostate,
  • lung, and
  • colorectal cancers [4]

However, studies examining the effectiveness of supplementation, whether involving medications, vitamins, or dietary components, have shown limited success in reducing the incidence of new cancer cases [17]

Ge et al. demonstrated that in a study involving 59,653, they evaluated the relationship between cancer and HF. In patients without cancer, the risk of mortality from cancer was higher (HR 1.36; 95% CI 1.09-1.69; P = 0.005); in patients with cancer, HF was associated with an elevated risk of death from cancer (HR 1.76; 95% CI 1.32-2.34; P < 0.001) [28]

Conclusions- Cancer and CVD, particularly HF, stand out as among the most widely acknowledged contributors to mortality and comorbidity globally. While preventive measures have contributed to reducing the incidence of both conditions, the complexities of risk prediction and management persist, particularly in cancer-related complications. Despite advances in understanding the interplay between immune system dysregulation, tissue inflammation, and oxidative stress in cancer-induced cardiac dysfunction, clinical recognition and systematic investigation of these phenomena remain limited…

It is noteworthy that cancer, through its hypermetabolic state, can act as a sole risk factor for HF, further underscoring the intricate interplay between these two disease entities. Oncologists frequently refer patients for cardiological evaluation to assess risk and monitor treatment effects.

They may also reveal common pathophysiological links between cancer and HF, prompting multifaceted preventive and therapeutic approaches.”

 

 

 

 

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