Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Curr Atheroscler Rep. 2019 Nov 19;21(12):50. doi: 10.1007/s11883-019-0810-x.
This review describes the effects of radiotherapy (RT) on coronary artery disease, its mechanisms, and clinical and laboratory evidence and discusses ways to minimize radiation-induced coronary atherosclerosis.
Radiation-induced cardiac toxicity is known in patients undergoing thoracic RT. One of the damages occurs in the coronary arteries, with accelerated atherosclerosis manifesting decades later. There is clinical and laboratory evidence of coronary damage in retrospective studies, systematic reviews, and meta-analyses. Clinical studies have shown that RT cardiotoxicity occurs decades after radiation, regardless of chemotherapy, and may occur earlier in patients with pre-existing risk factors or disease. The pathogenesis of radiation-induced coronary artery disease is complex and multifactorial, including endothelial dysfunction, altered vascular tone, hemostatic imbalance, and inflammatory activation. Some factors are responsible, such as mean heart dose, RT chest site, patient position, techniques, and breathing maneuvers. There are approaches to reduce radiation-induced cardiac toxicity. Among them, besides the mentioned factors, metformin and anti-inflammatory agents can minimize coronary damage, with impact on morbidity and mortality.
本文描述了放射治疗（RT）对冠状动脉疾病的影响、其机制，以及临床和实验室证据，并讨论了最大限度减少放射性冠状动脉粥样硬化的方法。
接受胸部 RT 的患者已知存在放射诱导性心脏毒性。其中一种损伤发生在冠状动脉，数十年后会加速动脉粥样硬化。在回顾性研究、系统评价和荟萃分析中有冠状动脉损伤的临床和实验室证据。临床研究表明，RT 心脏毒性在放射后数十年发生，与化疗无关，并且在有预先存在的危险因素或疾病的患者中可能更早发生。放射诱导性冠状动脉疾病的发病机制复杂且多因素，包括内皮功能障碍、血管张力改变、止血失衡和炎症激活。一些因素是负责的，例如平均心脏剂量、RT 胸部部位、患者体位、技术和呼吸动作。有一些方法可以降低放射诱导性心脏毒性。其中，除了上述因素外，二甲双胍和抗炎药可以最大限度地减少冠状动脉损伤，对发病率和死亡率有影响。
