Min San S, Wierzbicki Anthony S
aDepartment of Metabolic Medicine/Chemical Pathology, New Cross Hospital, West Midlands bDepartment of Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, London, UK.
Curr Opin Cardiol. 2017 Jul;32(4):441-447. doi: 10.1097/HCO.0000000000000404.
This article reviews the effects of radiotherapy and chemotherapy in promoting the progression of atherosclerosis in patients with cancer.
Radiotherapy is associated with an increase in the incidence of atherosclerosis with the effects being related to the site of irradiation and dose of radiotherapy. Cranial irradiation is associated with dyslipidaemia and the metabolic syndrome secondary to effect on growth hormone secretion. Chemotherapeutic oncological therapies are associated with numerous cardiac diseases including valve disease, pericarditis and cardiomyopathy but can also promote atherosclerosis. Therapies directed against vascular endothelial growth factor including tyrosine kinase inhibitors have a direct effect in raising blood pressure and increase rates of cardiovascular disease (CVD) events. Antimetabolites such as 5-fluorouraciland capecitabine cause chest pain and increase CVD events. Anthracyclines cause heart failure and may increase CVD risk.
There is increasing evidence that radiotherapy and some chemotherapeutic agents are associated with increased rates of CVD. Patients who have received treatment for cancer should be considered at higher risk of developing atherosclerosis and require increased monitoring, further investigation and earlier treatment than would be suggested by classical risk factor management strategies.
本文综述了放疗和化疗对癌症患者动脉粥样硬化进展的影响。
放疗与动脉粥样硬化发病率增加相关，其影响与照射部位和放疗剂量有关。头部放疗与血脂异常及继发于生长激素分泌受影响的代谢综合征有关。肿瘤化疗与多种心脏疾病相关，包括瓣膜病、心包炎和心肌病，但也可促进动脉粥样硬化。针对血管内皮生长因子的治疗，包括酪氨酸激酶抑制剂，对升高血压有直接作用，并增加心血管疾病（CVD）事件发生率。抗代谢药物如5-氟尿嘧啶和卡培他滨会引起胸痛并增加CVD事件。蒽环类药物会导致心力衰竭并可能增加CVD风险。
越来越多的证据表明，放疗和某些化疗药物与CVD发生率增加有关。接受过癌症治疗的患者应被视为发生动脉粥样硬化的风险较高，与经典危险因素管理策略相比，需要加强监测、进一步检查和更早治疗。
