Cleary Siobhan, Rosen Stuart D, Gilbert Duncan C, Langley Ruth E
MRC Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, UK.
Department of Cancer and Surgery, Imperial College Healthcare NHS Trust, London, UK.
BMJ Oncol. 2023 Oct 13;2(1):e000090. doi: 10.1136/bmjonc-2023-000090. eCollection 2023.
Advances in the detection and treatment of cancer have translated into improved cancer survival rates and a growing population of cancer survivors. These include those living with cancer and individuals free of the disease following treatment. Epidemiological studies demonstrate that cancer survivors are at an increased risk of cardiovascular disease (CVD), with cardiovascular (CV) mortality overtaking cancer mortality in some tumour types. Cancer and CVD share common aetiological risk factors, for example, age, tobacco use and obesity, as well as a shared inflammatory pathogenesis. The CV risks of mediastinal radiotherapy and chemotherapy, first observed in the 1970s with anthracyclines, have long been appreciated. More recently, targeted anticancer therapeutics (human epidermal growth factor receptor-2 targeted therpies, vascular endothelial growth factor inhibitors, second/third-generation BCR-ABL inhibitors, multiple myeloma therapies and combination RAF and MEK inhibitors in particular) as well as immunotherapies have added to the burden of treatment-related CV toxicity. Additionally, cancer therapy may indirectly impact on CV health by decreasing physical activity, increasing weight gain and accelerating the ageing process. Improving overall health outcomes by considering cardiological prevention and management in cancer survivorship is an area of increasing interest. CV risk factor assessment and management are recommended post-cancer treatment in accordance with primary prevention guidelines. The European Society of Cardiology 2022 guidelines also recommend enhanced surveillance after cancer treatments with a moderate to high risk of CV consequences. The aim of this article is to provide an overview of the interconnections between cancer and CVD, review current survivorship recommendations, and highlight key areas of ongoing and future research.
癌症检测与治疗方面的进展已转化为癌症生存率的提高以及癌症幸存者群体的不断扩大。这些幸存者包括癌症患者以及治疗后无癌个体。流行病学研究表明，癌症幸存者患心血管疾病（CVD）的风险增加，在某些肿瘤类型中，心血管（CV）死亡率已超过癌症死亡率。癌症和CVD有共同的病因风险因素，例如年龄、吸烟和肥胖，以及共同的炎症发病机制。纵隔放疗和化疗的CV风险早在20世纪70年代使用蒽环类药物时就已被发现，长期以来一直受到关注。最近出现的靶向抗癌疗法（特别是人表皮生长因子受体-2靶向疗法、血管内皮生长因子抑制剂、第二代/第三代BCR-ABL抑制剂、多发性骨髓瘤疗法以及RAF和MEK联合抑制剂）以及免疫疗法增加了与治疗相关的CV毒性负担。此外，癌症治疗可能通过减少体力活动、增加体重和加速衰老过程间接影响CV健康。通过在癌症幸存者中考虑心脏预防和管理来改善总体健康结果是一个越来越受关注的领域。建议根据一级预防指南在癌症治疗后进行CV风险因素评估和管理。欧洲心脏病学会2022年指南还建议在具有中度至高度CV后果风险的癌症治疗后加强监测。本文旨在概述癌症与CVD之间的相互联系，回顾当前关于幸存者的建议，并强调正在进行和未来研究的关键领域。
