Cardiovascular health: an important component of cancer survivorship
Cardiovascular health: an important component of cancer survivorship
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DOI：
10.1136/bmjonc-2023-000090
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发表时间：
2023-10
期刊：
影响因子：
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通讯作者：
S. Cleary;Stuart Rosen;D.C. Gilbert;R. E. Langley
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文献类型：
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作者：
S. Cleary;Stuart Rosen;D.C. Gilbert;R. E. Langley
癌症检测和治疗方面的进步已经转化为癌症存活率的提高和癌症幸存者人数的增加。这些人包括癌症患者和经过治疗后不再患病的人。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，心血管疾病（CV）死亡率超过癌症死亡率。癌症和心血管疾病具有共同的病因危险因素，例如年龄、吸烟和肥胖，以及共同的炎症发病机制。纵隔放疗和化疗的心血管风险，在20世纪70年代首次用蒽环类药物观察到，长期以来一直得到重视。最近，靶向抗癌治疗（人表皮生长因子受体-2靶向治疗，血管内皮生长因子抑制剂，第二/第三代BCR-ABL抑制剂，多发性骨髓瘤治疗，特别是RAF和MEK抑制剂联合治疗）以及免疫治疗增加了治疗相关CV毒性的负担。此外，癌症治疗可能通过减少身体活动、增加体重和加速衰老过程间接影响心血管健康。通过考虑癌症幸存者的心脏病预防和管理来改善整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进行癌症后治疗的心血管危险因素评估和管理。欧洲心脏病学会2022指南还建议在中度至高风险心血管后果的癌症治疗后加强监测。本文的目的是概述癌症和心血管疾病之间的相互关系，回顾当前的生存建议，并强调正在进行和未来研究的关键领域。
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.