Cardio-oncology: low-grade inflammation as a common pathway of cancer and cardiovascular disease

Extract

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Cardiac diseases and cancer are still the major causes of death.¹ Of note, with the impressive reduction in cardiovascular mortality, in particular due to prevention and modern management of acute coronary syndromes, cancer mortality has surpassed death rates from cardiac causes in some countries. However, an increasing number of cancer patients can be successfully treated, albeit increasingly so at the price of cardiovascular side effects such as pump failure,² coronary disease,³ acute coronary syndromes,⁴ and arrythmias. Furthermore, cancer and cardiac diseases are in large part age dependent and hence may occur incidentally together in the same patient. There is also evidence that some cancers and myocardial infarction share similar inflammatory pathways.⁵ Thus, it is timely that Kathleen Sturgeon and colleagues from the Pennsylvania State University in the USA report ‘A population-based study of cardiovascular disease mortality risk in US cancer patients’.⁶ The Surveillance, Epidemiology, and End Results (SEER) program was used to compare the US general population with 3 234 256 US cancer survivors. Among 28 cancer types, 1 228 328 patients or 38% died from cancer and 365 689 patients or 11% died from cardiovascular diseases. Among the latter, 76% of deaths were due to heart disease (Figure 1). In eight cancer sites, cardiovascular mortality risk surpassed index cancer mortality risk and was highest in survivors diagnosed at <35 years of age. Further, cardiovascular mortality risk was highest within the first year after cancer diagnosis, and cardiovascular disease mortality risk remained elevated throughout follow-up compared with the general population. Thus, the authors conclude that the majority of cardiovascular deaths occur in patients with breast, prostate, or bladder cancer. Of note, from the point of cancer diagnosis forward into survivorship, cancer patients are at elevated risk of dying from cardiovascular diseases, particularly those with childhood cancer,⁷ compared with the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from cardiovascular diseases, supporting early involvement of cardiologists in such patients and the establishment of cardio-oncology services.⁸ These important findings are put into context in an interesting Editorial by Joerg Herrmann from the Mayo Clinic Rochester in Minnesota, USA.⁹