AHA Releases Scientific Statement on Breast Cancer and CVD

For the first time the American Heart Association (AHA) has released a scientific statement on cardiovascular disease (CVD) and breast cancer. The document covers shared risk factors and the cardiovascular risks of cancer therapies, and also stresses the need for preventive cardiovascular therapies during and after a breast cancer diagnosis.

“The goal is for patients to be able to have discussions with their physicians about the side effects of cancer therapies, and for physicians to be aware of the potential for cardiotoxicities in these patients,” said Laxmi S. Mehta, MD (Ohio State University Wexner Medical Center, Columbus), chair of the writing committee, in an interview with TCTMD. “Every one of us will have a patient who has breast cancer, has heart disease, or has both simultaneously. So, it’s important for all of us, even though we are not oncologists, to be aware of what we can do for these patients,” she said. With no guidelines available in this area, Laxmi added that the AHA’s statement hopefully will spur additional research and interest in that direction.

The statement was published online February 1, 2018, ahead of print in Circulation.

A Starting Point for Discussion

In addition to reviewing the potential cardiovascular effects of such therapies as anthracyclines, alkylating agents, taxanes, antimetabolites, and endocrine therapy, the document points out that these effects can be early or delayed and can take many forms, the most commonly reported and monitored of which is LV systolic dysfunction. Some recent studies have shown that prophylactic beta-blocker therapy may prevent LV function declines. Other work suggests beta-blockers can influence breast cancer mortality or recurrence. The use of aspirin and statins is also discussed, since research suggests these may be protective for breast cancer patients, as may exercise training, although more research is needed in these areas, the paper states.

From a practical point of view, Laxmi noted that while interest in cardio-oncology is growing rapidly, cardiologists working in areas not affiliated with or supported by a collaborative program may be left with questions and concerns about how to effectively manage their patients with breast cancer or those who are survivors.

“This paper is a good starting point for discussion,” she told TCTMD. “There is still much more that we need to know, [but] this provides a framework.” Among the gaps in knowledge, she added, are how to predict cardiotoxicities earlier and the best ways to treat them.

Another important message from the document is that women who have survived breast cancer are more likely to die of CVD than women without a history of breast cancer. According to Laxmi and colleagues, the greater risk manifests itself about 7 years after the breast cancer diagnosis, “which highlights the need to reduce the additional burden of CVD during this time frame with early recognition and treatment of CVD risk factors.”