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Radiation CVD Risk Myeloma?

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Can radiation increase CVD risk for myeloma patients? Yes it can. The study linked below is talking about radiation in the most general terms. Think radiation from a CT scan.

I am a MM survivor. Part of my conventional therapies included cardiotoxic chemo regimens such as melphalan and adriamycin. I was diagnosed with chemotherapy-induced cardiomyopathy in 2010.

Even though chemo is different from radiation-induced heart damage, I decided to write about the study linked below in order to educate myeloma patients who undergo therapies that may cause CVD.


What is the increased risk of cardiovascular disease from radiation?

The increased risk of cardiovascular disease (CVD) from radiation exposure depends on factors such as the dose of radiation, the duration and frequency of exposure, the area of the body exposed, and individual susceptibility. Here’s a summary:

High-Dose Radiation

  • Therapeutic Radiation: Patients undergoing radiation therapy for cancer, especially in the chest area (e.g., breast, lung, or lymphoma), are at an increased risk of CVD.
    • This includes coronary artery disease, myocardial infarction (heart attack), heart failure, and valvular disease.
    • The risk is dose-dependent, with higher doses correlating with more damage.
    • Damage can occur through mechanisms like inflammation, fibrosis, endothelial cell injury, and accelerated atherosclerosis.

Low-to-Moderate Dose Radiation

  • Occupational or Environmental Exposure: Individuals exposed to low-to-moderate doses of radiation over long periods, such as nuclear industry workers or survivors of atomic bombings, also show an increased risk of CVD.
    • For doses below 1 Gy, studies suggest a linear increase in risk, but the magnitude is less than that seen with high doses.
    • Possible mechanisms include chronic low-grade inflammation and oxidative stress leading to vascular damage.

Epidemiological Findings

  • Studies of atomic bomb survivors indicate an increased risk of heart disease and stroke at doses as low as 0.5 Gy.
  • Survivors of cancer treated with radiation often show late-onset cardiovascular effects, sometimes manifesting decades after exposure.

Mechanisms of Radiation-Induced Cardiovascular Damage

  • Direct Damage: Radiation can damage endothelial cells lining blood vessels, promoting atherosclerosis.
  • Inflammatory Response: Radiation induces chronic inflammation and oxidative stress, further damaging vascular tissues.
  • Fibrosis: In therapeutic settings, radiation can lead to fibrosis of the heart muscle and pericardium.

Mitigation Strategies

  • Advances in Radiation Therapy: Modern techniques like intensity-modulated radiation therapy (IMRT) aim to minimize exposure to the heart and other critical structures.
  • Monitoring and Management: Survivors of cancer treated with radiation are often monitored for signs of CVD and may benefit from lifestyle interventions, medications, or other preventive measures.

Because my cardiotoxicity was diagnosed 15 years after my cardiotoxic treatments, I think that other MM patients may find themselves in a similar situation. By similar situation I am referring to radiation from imaging studies (CT, PET, etc) that may increase your risk of CVD risk.

man hand holding his nutritional supplemets, healthy lifestyle background.

In order to then lower your risk of CVD consider:

  • Exercise
  • Heart healthy nutrition
  • Heart healthy supplementation

Consider choosing an MRI rather than a CT scan. Do anything to avoid radiation.

Email me at David.PeopleBeatingCancer@gmail.com with questions or comments about heart health and MM.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Ionising radiation and cardiovascular disease: systematic review and meta-analysis

Objective: To systematically review and perform a meta-analysis of radiation associated risks of cardiovascular disease in all groups exposed to radiation with individual radiation dose estimates.

Design: Systematic review and meta-analysis.

Main outcome measures: Excess relative risk per unit dose (Gy), estimated by restricted maximum likelihood methods.

Data sources: PubMed and Medline, Embase, Scopus, Web of Science Core collection databases.

Eligibility criteria for selecting studies: Databases were searched on 6 October 2022, with no limits on date of publication or language. Animal studies and studies without an abstract were excluded.

Results: The meta-analysis yielded 93 relevant studies. Relative risk per Gy increased for all cardiovascular disease (excess relative risk per Gy of 0.11 (95% confidence interval 0.08 to 0.14)) and for the four major subtypes of cardiovascular disease:

  • ischaemic heart disease,
  • other heart disease,
  • cerebrovascular disease,
  • all other cardiovascular disease.

However, interstudy heterogeneity was noted, possibly resulting from interstudy variation in unmeasured confounders or effect modifiers, which is markedly reduced if attention is restricted to higher quality studies or those at moderate doses (<0.5 Gy) or low dose rates (<5 mGy/h).

For ischaemic heart disease and all cardiovascular disease, risks were larger per unit dose for lower dose (inverse dose effect) and for fractionated exposures (inverse dose fractionation effect).

Population based excess absolute risks are estimated for a number of national populations (Canada, England and Wales, France, Germany, Japan, USA) and range from 2.33% per Gy (95% confidence interval 1.69% to 2.98%) for England and Wales to 3.66% per Gy (2.65% to 4.68%) for Germany, largely reflecting the underlying rates of cardiovascular disease mortality in these populations.

Estimated risk of mortality from cardiovascular disease are generally dominated by cerebrovascular disease (around 0.94-1.26% per Gy), with the next largest contribution from ischaemic heart disease (around 0.30-1.20% per Gy).

Conclusions: Results provide evidence supporting a causal association between radiation exposure and cardiovascular disease at high dose, and to a lesser extent at low dose, with some indications of differences in risk between acute and chronic exposures, which require further investigation.

The observed heterogeneity complicates a causal interpretation of these findings, although this heterogeneity is much reduced if only higher quality studies or those at moderate doses or low dose rates are considered.

Studies are needed to assess in more detail modifications of radiation effect by lifestyle and medical risk factors.”

Radiation CVD Risk Myeloma?

Radiation CVD Risk Myeloma?

Radiation CVD Risk Myeloma?

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