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Cardiovascular Risks in Older Myeloma Survivors
It really shouldn’t be a surprise to document cardiovascular risks in older myeloma survivors. Though the article linked below cites heart risks for all older cancer survivors, my experience as a myeloma survivor, in particular, indicates cardiovascular risks in older myeloma survivors in particular.
I say this for several reasons.
First and foremost, the older person’s heart is… well…older. As we know, the heart is a muscle and if it is older it is less able to withstand the rigors of chemotherapy.
Secondly, the FDA approved standard of care for all newly diagnosed myeloma patients includes known chemotherapy regimens are are cardiotoxic aka cause damage to the heart.
Those cardiotoxic regimens are listed below. If you have undergone the FDA approved NDMM standard-of-care, you have probably undergone one or more cardiotoxic chemo regiments.
And lastly, chemotherapy and radiation are known to age patients, and cause inflammation- both of which can cause heart damage. It is only logical that the older myeloma patient’s heart may register that damage compared to a younger myeloma patient.
Which chemotherapy regimens used in the treatment of multiple myeloma are known to be cardiotoxic?
1. Anthracyclines (e.g., Doxorubicin)
- Doxorubicin, commonly used in combination regimens such as VAD (Vincristine, Adriamycin (doxorubicin), Dexamethasone), is one of the most well-known cardiotoxic drugs. It can cause:
- Acute cardiotoxicity: Occurs immediately after administration but is usually reversible.
- Chronic cardiotoxicity: Manifests months or years after treatment, leading to irreversible damage and heart failure due to cumulative doses.
2. Proteasome Inhibitors
- Carfilzomib is known to have an association with cardiotoxicity, especially in the form of:
- Heart failure
- Hypertension
- Ischemic heart disease
- While another proteasome inhibitor, Bortezomib, is generally less cardiotoxic, some cases of cardiac complications have been reported, though these are less frequent compared to Carfilzomib.
3. Immunomodulatory Drugs (IMiDs)
- Thalidomide and Lenalidomide (commonly used in regimens like Rd or VRd) can cause:
- Bradycardia
- Atrial fibrillation
- Venous thromboembolism, which indirectly increases cardiac risk.
- These agents are generally not directly cardiotoxic but can increase the risk of cardiovascular events.
4. Alkylating Agents
- Melphalan (used in high-dose therapy, especially with autologous stem cell transplant) is not typically associated with significant cardiotoxicity. However, it can cause some degree of cardiotoxicity, especially in older patients or those with pre-existing cardiac conditions.
5. Monoclonal Antibodies
- Daratumumab (anti-CD38) and Elotuzumab (anti-SLAMF7) are generally well tolerated from a cardiac standpoint, but rare cases of cardiac dysfunction have been reported, typically in patients with pre-existing heart disease or risk factors.
6. Corticosteroids
- High-dose corticosteroids like Dexamethasone, often used in multiple myeloma regimens, can lead to fluid retention, hypertension, and arrhythmias, increasing the risk of heart failure in vulnerable patients.
Monitoring and Prevention:
- Regular cardiac monitoring (e.g., echocardiograms, ECGs) is crucial, especially for patients on anthracyclines or Carfilzomib.
- Patients with pre-existing cardiovascular conditions should be carefully evaluated, and dose modifications may be required to reduce the risk of cardiotoxicity.
To put things in more concrete terms, according to research, 7.5% of myeloma patients develop CIC in the short-term.
There are another percentage of survivors who develop CIC in the longer term. For example, I was diagnosed with CIC 15 years to the day, after completing my autologous stem cell transplant.
It is difficult to put a number on these patients because so few of NDMM patients live for 15 or more years. But my point is that the average life expectancy is increasing so I believe that the cardiovascular risks of older myeloma patients will become known.
The solution? Undergo those heart healthy behaviors before, during and after conventional therapies. By this I mean heart healthy nutrition, supplementation and lifestyle therapies.
man hand holding his nutritional supplemets, healthy lifestyle background.
If you are a NDMM patient and would like to learn more about non-conventional heart healthy behaviors email me at David.PeopleBeatingCancer@gmail.com
Thank you,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Chemotherapy linked to increased cardiovascular risks in older cancer survivors
“A study based on clinical trial data found higher risks of stroke, heart attack, and hospital admission for heart failure in older cancer survivors. In the analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, chemotherapy was also linked to elevated rates of these conditions.
Although advances in treatment have led to decreased cancer mortality over the past decade, the growing numbers of cancer survivors may experience long-term effects of cancer and anticancer therapies. For example, the heart may be especially vulnerable to inflammation triggered by cancer and toxic effects from chemotherapy and radiation.
To investigate cardiovascular disease incidence in older cancer survivors and the impact of specific cancer treatments on heart health, a team led by Monash University’s Suzanne Orchard, PhD analyzed information from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, which included adults aged 70 years and older who were living in Australia and the United States.
Other studies have observed cerebrovascular diseases such as stroke and heart attacks following cancer treatment, but to the authors’ knowledge, this is the first that has explored the effects of individual treatment modalities on different cancer types, along with the impact of aspirin on rates of cerebrovascular diseases.
Of the 15,454 participants, 1,392 developed cancer over an average follow-up of 4.6 years. When the researchers assessed which participants experienced a cardiovascular disease event including:
- stroke,
- heart attack,
- or hospital admission for heart failure,
they found that the rate was twice as high in those who developed cancer compared with those who were cancer-free, at 20.8 versus 10.3 events per 1,000 person-years. (This means there would be an average of 20.8 and 10.3 cardiovascular disease events among 1,000 people over one year in the respective groups.) This elevated risk-;which was seen across the different cardiovascular outcomes-;remained even after accounting for traditional cardiovascular disease risk factors.
The incidence of cardiovascular disease events was greatest in patients with metastatic, blood, and lung cancers. Also, chemotherapy was associated with a 2-times higher risk of cardiovascular disease events.
Analyses were inconclusive regarding other systemic therapies such as hormonal therapy, targeted therapy, immunotherapy, and radiation therapy-;although thoracic radiation is known to confer an elevated risk. Aspirin (the clinical trial intervention in the trial) did not impact cardiovascular disease incidence.
Dr. Orchard stressed the importance of early screening and preventive measures as early as possible because cardiovascular risks in older myeloma survivors and the need for continued research to further protect cancer survivors’ cardiovascular health…
“Our research contributes to the growing body of work indicating that cancer- and treatment-related cardiovascular disease is a very real risk in cancer survivors. Cardiovascular disease can have a significant impact on both quality of life and survival for patients with cancer. Fortunately, with early screening and preventative measures, some of the cancer-related risks can be mitigated.”