Endo cancer and cardiovascular death

Very interesting article. I just saw my primary care doctor and asked about going on a statin but he said based on my cardiovascular risk score I didn’t need a statin. So after reading this most current study I am wondering if or when and how their cardiovascular risk decisio tool will be adjusted to reflect the nuisances of a cancer survivor. I am going to send this article to my primary care doctor. Would be a great article to give to a cardiologist too. Thank you for posting! 

Thanks for sharing this article. Interesting and sure makes me think about getting off of my butt and on the treadmill for sure! My cholesterol and triglycerides are not where they should be. My GP gave me a year to get them down or go on meds. Hopefully, I'm going in the right direction. But, after reading this, I may be more open to taking meds if I'm not....  My weight is within the healthy catagory but I know I can do more cardio than I do. Heart disease runs heavily in my family - both parents and 3 brothers.... UGH! 

Love and Hugs,

Cindi

The full study article is interesting. It's subject to many limitations and the article discusses that too. Still, seems rather relevant to us. Below are excerpts that pertain directly to endometrial cancer. 

"We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients."

"In Take home figure, we observed that relative to the average SMR for all 28 cancer sites, endometrial cancer has the greatest risk of mortality from heart disease at all time points following diagnosis."

"Of particular importance would be future studies addressing early cardiology evaluation and how aggressive cardiology care should be in cancer patients. Such studies of interventional cardio-oncology following cancer diagnosis might focus on cancers of the larynx and endometrium as these patients have a good cancer prognosis but relatively high risk of CVD mortality, particularly in the first year following diagnosis."

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz766/5637730

Also an interesting editorial about the study:

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz781/5637731

The study or commentary make the point that some of the risk is due to heart disease and some cancers sharing lifestyle risk factors, and that diet, weight, exercise, etc. are definitely a prime target. It's not a new guideline sending us all off to cardiologists, it's an observational study intended to direct further focus and research. Also, most heart disease, and even more so heart disease risk,  is managed by primary care anyway, unless severe/complicated, or invasive intervention is needed.

I wonder if some of the increased risk is due to not managing CV risk or CV disease as aggressively, due to a perceived lack of benefit ... thinking we're probably just going to die of cancer anyway ... maybe a subconscious bias, but there nonetheless.

MAbound said:

Hmmm....

My first reaction on reading this thread and the article, especially since I'm almost 3 years out from treatment, is "Oh, crap, not another specialist!". I've gotten excited about having fewer doctor appointments since cutting back to 6 month follow-ups alternating between my gyn-oncologist and regular gynecologist who are part of the same practice. That translates into three less doctor appointments per year and has me doing my happy dance and not too enthusiastic about adding a new member to my team. We all have to die from something, right? I think I'd rather go quick from a heart attack than go slow from a recurrence, to tell the truth.

Am I crazy? Maybe. But this article, if nothing else, serves as further motivation to be careful about my diet, weight, and exercise for this concern as well as the cancer coming back. I'm still working on getting off what I gained while on megace. I think my PCP is watching for symptoms of CVD, anyway, because of being on Metformin for diabetes now, but so far my lab work otherwise looks good. Do I really need to go to a cardiologist, too? 

I think I will messege my gyn-oncologist with a link to ask his thoughts about going to see a cardiologist. That might carry more weight with my PCP than if I bring it up with him given what I know about my current heart health indicators. Given that there are some limiting factors to the study and that there are as yet no other studies that replicate the results, I don't think what we are reading here is a one-size-fits-all recommendation, but is rather food-for-thought based on our individual health situations such as the endometrial cancer along with family histories and other existing health issues.

Studies always need to be read with a bit of skepticism because there is a lot of junk science out there. This is a good study, but it is just one and has acknowledged limiting factors. It may carry more weight (at least with me) in the future if subsequent studies can address its limitations and get similar results. 

 

MAbound

I thought some of the same thoughts you did. I dont want to worry about having a heart attact at age 47. My family doesnt have a history of heart deasese. After reading that article I thought great most of my my family lives a long time (all grandparents died at 80 plus years or more) but because i had cancer i will be the one that wont.

So thats just it. Just MABound said we are all going to die some time. I too am trying to not go tovthe doctors as much. I to graduated to my six mounth check ups. Really excited about that too.

All due respect. I think i will wait until this spring when i see my PC to think about neat deasease.

cmb said:

Heartburn or Heart Attack

During chemo I had heartburn occasionally – not something I had before or after treatment. So based on the nurse's suggestion, I would take Prevacid periodically.

One night just after I went to bed I started having chest pain similar to that which I got from heartburn. This time, however, it was much worse than usual and I ended up getting out of bed and sitting upright in a chair. As I sat there I debated whether I was actually having a heart attack instead of just a really bad case of heartburn.

I thought about it for a while and decided that I'd rather go fast from a heart attack than slow from cancer, so I didn't seek medical assistance. Probably not the soundest decision and not something that I would recommend to others, but I was feeling really miserable on the Ifosfamide/Adriamycin and not that optimistic about my long-term survival prospects at that time.

If it had happened again, I would have been more proactive, but it never did. And the medications I take have kept my blood pressure and cholesterol levels within the normal ranges so far. But as I mentioned above, I have thought about having another echo to check on my heart function after the Adriamycin.

I had adriamyacin as well as I was very allergic to taxol and couldn't desensitize. I have a friend who did have heart damage due to this chemo so I was really worried. I had the required echo at the beginning and one at the end. Fortunately all was well but it is a little scary. I noticed this chemo caused heartburn as well. For some reason salty snacks helped. Maybe it was in my head but it worked.

BluebirdOne said:

Thanks for this.

In my case, I have had super high cholesterol (hereditary) and have been on statins for 25 years which barely keep it under control. After a life time of low blood pressure, I developed high blood pressure at the time of my cancer dx, which my cardiogist dismissed as “ white coat syndrone”, insulting, and untrue. My blood pressure is great now with medication. To round out the trifecta, I have had bradycardia for about ten years with my heart rate in the low 40’s, which everyone except my wonderfful dentist has ignored, because I don’t faint. The most common response to the low heart rate is, “oh, you are an athlete?”. To which I respond trying to hide my excess chubb, do I look like an athlete that would have a low heart rate?, which shuts them up, but then do not offer any treatment. This study will now force me to pay more attention to my heart health as there is a history of stroke in my family. I would not mind dying imm from a heart attack, but having a devastating stroke is what I fear. My mother had a terrible stroke at 62 and spent the last years of her life half paralyzed, totally disabled and suffered for from vascular dementia. It is a horrible way to die. Stroke is what I fear. 

Bradycardia is also called heart block, of which there are different types or degrees. They are all caused by issues with the electrical conduction in the heart as opposed to problems caused by poor blood supply to the heart. Precisely which you have would be diagnosed by an EKG which you probably at least last had prior to your surgery because it's a test required for every hospital admission. Here's a link that describes them:

https://www.hrsonline.org/patient-resources/heart-block

You may want to ask at your next doctor visit which kind your last EKG showed to understand if the do-nothing treatment is the right one for you or if you have the kind that can eventually progress to needing a pacemaker. It sounds like you have the former, but you need to have confidence that your doctor is keeping a watchful eye on the situation and not being dismissive. 

I have fight bundle branch block and my husband has left bundle branch block. I've learned that those are both conditions that just about everybody gets as a part of aging and that they are no big deal. Nothing is done for such a diagnosis, either.

I'm with you about the fear of stroke. It's an awful, prolonged way to go and a great burden to family members. One concern I'd have about such a slow heart rate even if you are not fainting is does it increase your risk for a blood clot that could cause a stroke? It would be an interesting question to ask or research.

Your comment about white coat syndrome is interesting because my husband has that. It's a real thing and not meant to be insulting. It just means that he usually gets his blood pressure checked a second time just as they are done with his physical to get a more accurate reading. He's generally a lot less anxious at that point. 

I am treated for hypertension, but I was also diagnosed by the Director of UPenn's Hypertension program with white coat hypertension.  Of course, hypertension should not be ignored, but it also should not be overtreated as excessive hypertension medication carries its own risks, including life-threatening falls.  Because I have both conditions, I will not agree to any change in my hypertension medication unless I have had a recent 24-hour blood pressure monitor test.  When I am tested at the doctor's office, my readings are typically high and volatile.  When I wear the 24-hour monitor, my readings are for the most part normal during the waking hours and low (80s or 90s over 40s or 50s) during the sleeping hours.  If I had been given additional BP medicine based solely on office readings, there's a good chance I would have passed out on my way to the bathroom at night.  I feel even more strongly about this issue, as someone I know fell and hit her head and died earlier this year.  Don't know if it was medication-related, but falls are serious business.  

I didn't see that any of the above posts mentioned 24-hour blood pressure monitors with respect to high blood pressure, so I thought I would raise what I believe to be an important issue.  For those of you who may not know, the monitors I've worn take readings every 15 minutes during the day and every 30 minutes at night.  Then averages are calculated (overall average and day and night average).  I always find the results interesting and informative.  It's fun to see if I can relate particularly stressful events that happened during the day I'm wearing the monitor to increased readings in the overall test results.

MoeKay said:

Hypertension and White Coat Hypertension

I am treated for hypertension, but I was also diagnosed by the Director of UPenn's Hypertension program with white coat hypertension.  Of course, hypertension should not be ignored, but it also should not be overtreated as excessive hypertension medication carries its own risks, including life-threatening falls.  Because I have both conditions, I will not agree to any change in my hypertension medication unless I have had a recent 24-hour blood pressure monitor test.  When I am tested at the doctor's office, my readings are typically high and volatile.  When I wear the 24-hour monitor, my readings are for the most part normal during the waking hours and low (80s or 90s over 40s or 50s) during the sleeping hours.  If I had been given additional BP medicine based solely on office readings, there's a good chance I would have passed out on my way to the bathroom at night.  I feel even more strongly about this issue, as someone I know fell and hit her head and died earlier this year.  Don't know if it was medication-related, but falls are serious business.  

I didn't see that any of the above posts mentioned 24-hour blood pressure monitors with respect to high blood pressure, so I thought I would raise what I believe to be an important issue.  For those of you who may not know, the monitors I've worn take readings every 15 minutes during the day and every 30 minutes at night.  Then averages are calculated (overall average and day and night average).  I always find the results interesting and informative.  It's fun to see if I can relate particularly stressful events that happened during the day I'm wearing the monitor to increased readings in the overall test results.

 

I want one of those too if someone tries to put me on a medication (not that I expect that soon). They recently lowered the upper limits of normal BP, but they don't recommend medications for "elevated" BP. 

MoeKay said:

Hypertension and White Coat Hypertension

I am treated for hypertension, but I was also diagnosed by the Director of UPenn's Hypertension program with white coat hypertension.  Of course, hypertension should not be ignored, but it also should not be overtreated as excessive hypertension medication carries its own risks, including life-threatening falls.  Because I have both conditions, I will not agree to any change in my hypertension medication unless I have had a recent 24-hour blood pressure monitor test.  When I am tested at the doctor's office, my readings are typically high and volatile.  When I wear the 24-hour monitor, my readings are for the most part normal during the waking hours and low (80s or 90s over 40s or 50s) during the sleeping hours.  If I had been given additional BP medicine based solely on office readings, there's a good chance I would have passed out on my way to the bathroom at night.  I feel even more strongly about this issue, as someone I know fell and hit her head and died earlier this year.  Don't know if it was medication-related, but falls are serious business.  

I didn't see that any of the above posts mentioned 24-hour blood pressure monitors with respect to high blood pressure, so I thought I would raise what I believe to be an important issue.  For those of you who may not know, the monitors I've worn take readings every 15 minutes during the day and every 30 minutes at night.  Then averages are calculated (overall average and day and night average).  I always find the results interesting and informative.  It's fun to see if I can relate particularly stressful events that happened during the day I'm wearing the monitor to increased readings in the overall test results.

 

Thanks for your input. In the spring of 2018 a month or so before dx with cancer, my blood pressure was spiking, daily, but was almost normal at other times. I had purchased a high quality blood pressure cuff and upon the advice of my internist was taking my blood pressure twice a day. I was not on blood pressure medication at the time, had many doctor’s visits during that time to figure out the gyne stuff, sudden high blood pressure, and my normal physical, blood work. etc. so I had many BP readings, high and normal. I have been on baby aspirin for about 10 years. During this time my cardiologist ordered a stress test, which had to be stopped due to the fact I started out with the highest BP numbers I have ever had. The results were inconclusive. The cardiologist wanted me to have the 24 hour BP test but I refused as I sleep so poorly that I knew that the every 20 minute reading would keep me up all night and my readings would be skewed by lack of sleep. He pooh poohed me, said that I had WCS, even though when I pointed out that my reading taken by his nurse was normal just minutes before, he admitted he did not even look to see what my BP was by his own nurse. (I got rid of him) So almost normal BP when I am seeing my cardiologist, yet he said I had WCS. BS. So I was put on BP medication by my internist and my readings are back to my lower normal readings. Before BP medication, with my many visits to various docs, my BP could be normal or spiking. Now, no high readings at doctor visits or any other times. Of course immediately after that started on the road to cancer dx, hysteroscopy, hysterectomy, chemo, radiation, and my BP has been under control for the most part. With this new study and my constellation of issues, and NED, I will ask them to do a full cardio work up because now that I am not actively being treated for cancer I have been concentrating on the health issues that have been put on the back burner. (cataract surgery for one)