Breast Cancer Therapies Associated With Increased Risk for Cardiovascular Disease

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It's vital that clinicians be able to identify patients at risk for cardiovascular complications from their cancer treatment.
It's vital that clinicians be able to identify patients at risk for cardiovascular complications from their cancer treatment.

Certain anticancer therapies may increase the risk of cardiovascular disease (CVD) for patients with breast cancer, a study published in Circulation has shown.

The likelihood of cancer survivors dying from CVD vs cancer recurrence is increasing due to the improved efficacy of breast cancer therapies, making effective management and prevention of CVD a priority for this patient population as they age.

Chemotherapeutic agents (eg, anthracyclines, alkylating agents, taxanes, and antimetabolite drugs), endocrine therapies, HER2-targeted therapies (eg, trastuzumab, pertuzumab), novel emerging therapies, and radiotherapy are associated with increased incidence of many cardiovascular diseases including left ventricular dysfunction (LVD), arrhythmias, conduction abnormalities, heart failure, thrombosis, and cardiomyopathy.

Identifying at-risk patients is crucial. Myocardial strain imaging with speckle-tracking echocardiography is an effective predictor of cardiac dysfunction in patients receiving chemotherapy for breast cancer. Biomarkers such as brain natriuretic peptide (BNP) and troponin I are indicators of chemotherapy-induced cardiac disease and may accurately reflect radiotherapy-induced cardiotoxicity occurrence as well.

Changes in clinical practice may also reduce the risk of CVD for patients with breast cancer. Previous studies have shown that the administration of dexrazoxane to patients receiving chemotherapy may decrease the incidence of heart failure and cardiac events. Delivery methods, such as doxorubicin as an intravenous infusion instead of a bolus dose, or liposomal formulations of doxorubicin compared to standard preparations, may preserve the efficacy of therapy while reducing the incidence of cardiotoxicity.

Pharmacotherapy may also be an effective strategy for reducing the risk of CVD and breast cancer. Previous studies have suggested that prophylactic therapy with β-blockers, ACE-inhibitors, ARBs, statins, and aspirin may improve long-term outcomes for patients with breast cancer. Exercise and survivorship programs may also improve CVD risk among survivors.

The authors concluded that “with the evolving intersection of the cardiovascular and oncologic fields, comprehensive care is an essential element in the management of cancer patients to maximize gains in cancer treatment while minimizing the potential deleterious impact on cardiovascular health.”


Mehta LS, Watson KE, Barac A, et al. Cardiovascular disease and breast cancer: where these entities intersect [published online January 31, 2018]. Circulation. doi: 10.1161/CIR.0000000000000556
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