Sex-Specific Cardiovascular Risks of Cancer and Its Therapies.
Sex-Specific Cardiovascular Risks of Cancer and Its Therapies.
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DOI：
10.1161/circresaha.121.319901
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发表时间：
2022-02-18
影响因子：
20.1
通讯作者：
Ky B
中科院分区：
文献类型：
--
作者：
Wilcox NS;Rotz SJ;Mullen M;Song EJ;Ky Hamilton B;Moslehi J;Armenian SH;Wu JC;Rhee JW;Ky B
在心血管疾病和癌症中，存在基于性别的患病率和结果差异。男性和女性在癌症治疗后心脏毒性的风险方面也可能不同，包括心力衰竭（HF）、心肌病、动脉粥样硬化、血栓栓塞、心律失常和心肌炎。在这里，我们描述了性别差异的流行病学和病理生理学的心脏毒性与蒽环类药物，造血干细胞移植（HCT），激素治疗和免疫治疗。相对于男性，青春期前女性蒽环类药物诱导的心脏毒性风险较高，绝经前女性较低，绝经后女性相似。对于自体HCT，一些研究表明女性淋巴瘤患者晚期HF的风险增加，但同种异体HCT尚未显示基于性别的差异。激素治疗（包括GnRH调节剂、雄激素受体拮抗剂、选择性雌激素受体调节剂和芳香酶抑制剂）与心脏毒性（包括心律失常和静脉血栓栓塞）相关。然而，基于性别的差异尚未得到阐明。与免疫治疗相关的心脏毒性的性别差异评价有限，部分原因是相关临床试验中女性参与率较低。然而，一些研究表明，女性患免疫检查点抑制剂心肌炎的风险增加，尽管这并没有得到一致的证明。对于上述每种癌症治疗，我们根据心脏毒性管理考虑了基于性别的差异。我们确定知识差距，以指导未来的机制和前瞻性临床研究。进一步了解癌症治疗心脏毒性的性别差异，可以促进有针对性的预防和治疗心脏保护策略的发展。
In both cardiovascular disease and cancer, there are established sex-based differences in prevalence and outcomes. Males and females may also differ in terms of risk of cardiotoxicity following cancer therapy, including heart failure (HF), cardiomyopathy, atherosclerosis, thromboembolism, arrythmias and myocarditis. Here, we describe sex-based differences in the epidemiology and pathophysiology of cardiotoxicity associated with anthracyclines, hematopoietic stem cell transplant (HCT), hormone therapy and immune therapy. Relative to males, the risk of anthracycline-induced cardiotoxicity is higher in pre-pubertal females, lower in pre-menopausal females, and similar in post-menopausal females. For autologous HCT, several studies suggest an increased risk of late HF in female lymphoma patients, but sex-based differences have not been shown for allogeneic HCT. Hormone therapies including GnRH modulators, androgen receptor antagonists, selective estrogen receptor modulators and aromatase inhibitors are associated with cardiotoxicity including arrhythmia and venous thromboembolism. However, sex-based differences have not yet been elucidated. Evaluation of sex differences in cardiotoxicity related to immune therapy is limited, in part due to low participation of females in relevant clinical trials. However, some studies suggest that females are at increased risk of immune checkpoint inhibitor myocarditis, although this has not been consistently demonstrated. For each of the aforementioned cancer therapies, we consider sex-based differences according to cardiotoxicity management. We identify knowledge gaps to guide future mechanistic and prospective clinical studies. Furthering our understanding of sex-based differences in cancer therapy cardiotoxicity can advance the development of targeted preventive and therapeutic cardioprotective strategies.