Breast Cancer and Heart Disease

CypressCynthia said:

I'm not sure, but I would
I'm not sure, but I would think that you are probably not high enough risk at your age to consider much besides a baby aspirin. However, I don't know your health, etc., so ask your doc!

Lynn Smith said:

Thank You
Thank you for the information.I've been on a beta blocker for over 30 years.It would be nice to know if fights off this beast we all have.

Lynn Smith

CypressCynthia said:

Me too. It definitely is
Me too. It definitely is not a lay person's term--very formal. That's why I didn't put it in my header!

CypressCynthia said:

Duke Article
Breast Cancer and Cardiovascular Injury: Prevention and/or Treatment Approaches

Preventive and/or treatment strategies will be required to define and offset the acute and long-term clinical consequences of the "multiple hit." Unfortunately, it is not currently known whether treatment of risk factors modifies CVD (cardiovascular disease) incidence among women with breast cancer to the same extent as in general population. However, at least one clinical trial has examined the effects of angiotensin-converting enzyme inhibition (ACEI) on preventing cardiac dysfunction among cancer patients. Based on their prior work, Cardinale et al.[37] randomized patients who experienced an increase in troponin I shortly after chemotherapy to receive an ACEI (enalapril) or usual care for 12 months. Results indicated a significant reduction in LV (left ventricular) function among usual care patients only.[37] In a retrospective study, Ewer et al.[38] reported that maximum-tolerated doses of ACEI and beta-blockers allowed therapy to be reinitiated among breast cancer patients who initially had treatment discontinued due to trastuzumab-induced heart failure. On the basis of these findings and our own clinical experience, treatment of risk factors consistent with the American Heart Asssociation guidelines for prevention of CVD in women[39] appears prudent. Effective strategies to preserve LV function are of major importance because therapy is withheld when LVEF (left ventricular ejection fraction) decreases <50% and not resumed until LVEF is ≥50%, which has obvious implications for clinical outcome of breast cancer patients.

Recommendations for the treatment of major risk factors include optimal lifestyle behaviors in conjunction with pharmacotherapy, as required. Specifically, beta-blockers and/or ACEI, with the addition of other agents (e.g., thiazides), are recommended for the initial therapy of hypertension. Regarding hypercholesterolemia, the use of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors (statins) is recommended to achieve low-density lipoprotein cholesterol <100 mg/dl. The use of sulfonylurea or biguanide (metformin) is recommended for women with type II diabetes mellitus to achieve a glycosylated hemoglobin (HbA1c) <7%.[39] Of note, exercise training may be effective in this setting because of its demonstrated effects on cardiovascular reserve, individual risk factors, and overall reductions in CVD mortality.[40,41] Moreover, a recent meta-analysis[42] reported that exercise training resulted in a significant improvement in exercise capacity among women with early breast cancer while epidemiologic data suggested that greater physical activity after therapy was associated with decreased breast cancer-specific and all-cause mortality.[43] Only one study to date has examined the effects of exercise training on CVD risk factors among early breast cancer patients.[44]

There is also a paucity of data examining any adverse or beneficial effects of recommended risk factor-modification strategies on cancer outcomes. However, several preclinical studies have demonstrated that lipophilic statins (e.g., simvastatin, fluvastatin), ACEI, and metformin have antineoplastic activity in several experimental models of breast carcinogenesis.[45–47] On the basis of these promising data, several clinical trials are underway to investigate the potential antitumor efficacy of these agents in breast cancer patients. As a cautionary note, all preclinical studies have examined the potential efficacy of CVD medications without concurrent cancer therapy. Thus, little is known about the potential interaction between these agents.

Pharmacologic CVD medications as well as lifestyle approaches (e.g., exercise training) influence a wide spectrum of biological processes that may be particularly relevant for the antineoplastic effects of cancer therapies. For example, in addition to their vasodilatory effects, ACEI and exercise training are also potent antioxidants and actively scavenge ROS and lower oxidative stress.[48] Because radiotherapy and certain cancer chemotherapeutics rely on ROS-mediated deoxyribonucleic acid damage to induce apoptosis, one could speculate that these interventions might inhibit the efficacy of these therapies. On the other hand, reduction in ROS oxidative damage may confer protection against doxorubicin-induced cardiac toxicity.[48]

Similarly, statins and exercise therapy increase the production, number, and function of circulating EPCs via vascular endothelial growth factor-dependent mechanisms.[49,50] Several reports have demonstrated that EPCs significantly contribute to tumor angiogenesis;[51] thus, one might speculate that interventions that induce EPC activity would augment tumor growth. Paradoxically, however, preclinical studies have reported that statins and exercise (without concurrent antitumor therapy) inhibit established breast tumor growth and metastatic progression.[52] Although strategies that improve overall global tumor blood flow may improve the delivery and efficacy of anticancer drugs in established breast tumors,[53] in the adjuvant setting where treatment is directed at micrometastases, the clinical relevance of these observations is unknown. Clearly, the use of any risk factor modification strategy during early breast cancer therapy needs to be rigorously evaluated using appropriate end points (e.g., cardiac and cardiovascular function, adverse events, cancer drug pharmacokinetics, and relapse-free survival).</p>

CypressCynthia said:

Unfortunately, cancer care
Unfortunately, cancer care is not well coordinated. It would be nice to be able to visit a cancer center where they included psych care, cardiac care, palliative care, etc. Maybe if we squeak loud enough, maybe one day it will happen.