Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 260, New York, NY, 10065, USA,
Curr Atheroscler Rep. 2015 Mar;17(3):484. doi: 10.1007/s11883-014-0484-3.
Cancer survivorship should be defined starting not from completion of treatment, but from the time of diagnosis. Assessing and controlling the cancer patient's cardiovascular risk before, during, and after treatment is crucial to improving their overall outcome. There are many cancer therapies, including but not limited to anthracyclines, radiation, and vascular signaling pathway inhibitors which should be considered nontraditional cardiovascular risk factors with significant morbidity. Monitoring novel populations, such as a younger age group, for ischemic coronary disease or congestive heart failure (CHF) is not intuitive to many clinicians. Symptoms of CHF and coronary artery disease overlap with common side effects of cancer and cancer treatment. Cancer survivors may also have fewer typical symptoms of cardiovascular disease. Increased surveillance and aggressive control of cardiovascular disease is important in cancer patients both while undergoing active treatment and in the long term. Despite the increasing interest in cardio-oncology, data-driven guidelines are lacking due to small study sizes and low event rates over a short period of time. Most practice guidelines have been based on clinical practice and expert opinion. The list of cardiotoxic cancer therapies continues to grow each year. This review is not intended to be a comprehensive review of all cancer therapy toxicity, but will focus on recent literature regarding prevention of CHF and coronary artery disease (CAD) during active cancer therapy as well as current screening guidelines for long-term survivors.
癌症生存应该从诊断时而不是治疗完成时开始定义。在治疗前、治疗中和治疗后评估和控制癌症患者的心血管风险对于改善其整体预后至关重要。有许多癌症治疗方法，包括但不限于蒽环类药物、放疗和血管信号通路抑制剂，它们应被视为具有显著发病率的非传统心血管危险因素。对于许多临床医生来说，监测包括年轻人群在内的新型人群是否患有缺血性冠心病或充血性心力衰竭（CHF）并不是直观的。CHF 和冠心病的症状与癌症和癌症治疗的常见副作用相重叠。癌症幸存者的心血管疾病的典型症状也可能较少。在癌症患者中，无论是在积极治疗期间还是长期治疗期间，增加对心血管疾病的监测和积极控制都很重要。尽管人们对肿瘤心脏病学越来越感兴趣，但由于研究规模小，短时间内事件发生率低，缺乏基于数据的指南。大多数实践指南都是基于临床实践和专家意见制定的。每年都会有更多的心脏毒性癌症治疗方法被发现。本文的综述并非旨在全面综述所有癌症治疗毒性，而是将重点放在最近关于在积极癌症治疗期间预防 CHF 和冠心病（CAD）的文献以及长期幸存者的当前筛查指南上。
