Linking Heart Failure to Cancer: Background Evidence and Research Perspectives
Linking Heart Failure to Cancer: Background Evidence and Research Perspectives
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DOI：
10.1161/circulationaha.118.033603
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发表时间：
2018-08-14
期刊：
影响因子：
37.8
通讯作者：
Ameri, Pietro
中科院分区：
文献类型：
--
作者：
Bertero, Edoardo;Canepa, Marco;Ameri, Pietro
最近的流行病学分析表明，先前存在心力衰竭（HF）的患者比没有心力衰竭的患者更容易发生癌症。反对这一观点的论点是，由于医学观察的加强，心衰患者两种高患病率疾病同时出现的机会增加，肿瘤检测增加。然而，生物学数据支持心衰是一种致癌性疾病的假设。神经激素激活与癌症的发生、进展和传播有关，这些研究并不是专门针对心衰的，现在，根据新的证据，心衰患者比对照组更容易被诊断出肿瘤，这些研究被重新评估。此外，需要考虑的一个发人深省的情况是，一个系统性紊乱的环境，其中低度炎症起主要作用，导致心衰和恶性肿瘤，从而将一种疾病与另一种疾病联系起来。在动物模型中，缺血后HF已被证明能促进肿瘤生长。探索这些和其他可能将HF与恶性肿瘤联系起来的途径是一个新的和令人兴奋的研究领域，其最终目标是回答HF是否确实促进癌症的问题。
Recent epidemiological analyses suggest that incident cancer may be more common among patients with preexisting heart failure (HF) than in patients without HF. Arguments against this notion have been the increased chance of co-occurrence of 2 high-prevalence conditions and increased tumor detection in patients with HF because of intensified medical observation. However, biological data lend support to the hypothesis that HF is an oncogenic condition. Neurohormonal activation has been related to cancer initiation, progression, and dissemination by studies not specifically focusing on HF, which are now reappraised in the light of the emerging evidence that tumors are diagnosed more often in HF than control cohorts. Furthermore, a thought-provoking scenario to be considered is that a systemically perturbed milieu, where low-grade inflammation plays a primary role, leads to both HF and malignancy, thus connecting 1 disease to another. Postischemic HF has been shown to promote tumor growth in an animal model. Exploring these and other pathways potentially linking HF to malignancy is a new and exciting field of research, with the ultimate goal of answering the question of whether HF does promote cancer.