2023-08-04 15:15:14
Breast cancer survival rates have improved considerably in recent decades, but the factors that increase the likelihood that patients will develop cardiovascular side effects, such as cardiotoxicity, are not well understood or well treated.
A recent study conducted on patients from the northeastern region of Colombia has revealed that 11.94% of patients with a high body mass index (BMI) treated for breast cancer in a regional center suffered cardiac damage or cardiotoxicity during chemotherapy .
“Cardiotoxicity is a relatively recent concern in cancer care, and its recognition as a major problem is still evolving. In regions with limited research infrastructure and resources, there may be a lack of specific studies or initiatives addressing cardiotoxicity in the context of breast cancer treatment,” said study lead author Ivetteh Gaibor Santos, an internal medicine specialist at the Autonomous University of Bucaramanga / Santander-Foscal Ophthalmological Foundation in Bucaramanga (Colombia), and specialist doctor in cardiology at the University Foundation of Health Sciences / San José Hospital in Bogotá (Colombia).
An anonymous database of breast cancer patients who began chemotherapy with doxorubicin or trastuzumab between January and December 2021 was used for the study. The analysis only included patients who had a baseline echocardiogram and at least one follow-up echocardiogram. The database also recorded sociodemographic, oncological, cardiovascular, and echocardiographic variables.
Cardiotoxicity was defined as a decrease in left ventricular ejection fraction (LVEF) of more than 10%, reaching a value below 50% or a relative reduction of more than 15% in global longitudinal strain in patients with a normal LVEF. The ejection fraction is the amount of blood that the heart pumps each time it beats. A normal ejection fraction is 50% or more.
The study cohort included 67 patients, with an average age of 55 years and an average body mass index (BMI) of 26.18 kg/m². The BMI is obtained from the mass and height of a person. Baseline characteristics of the study cohort included obesity (20.9%), hypertension (14.93%), and type 2 diabetes (13.43%). All patients had a normal LVEF before starting chemotherapy.
The results found that the prevalence of cardiotoxicity was 11.94%. A body mass index of 25 or more (overweight/obese) was the only predisposing risk factor for developing this adverse effect.
“Obesity is itself a risk factor for the development of breast cancer and cardiovascular diseases such as heart failure, but it is often not adequately treated, unlike other prevalent risk factors such as high blood pressure,” he said. Gaibor Santos, who added that all the patients in this study were taking antihypertensive drugs. He also added: “Chemotherapeutic drugs, which are formulated according to body surface area rather than body composition, may lead to an increased risk of cardiotoxicity in obese patients due to over- or under-dosing.”
Artist’s impression of a cancer cell. (Illustration: Amazings/NCYT)
According to the study authors, early diagnosis of cardiotoxicity and related factors is critical for treating physicians to reduce adverse outcomes.
To raise awareness about the risks of cardiotoxicity in cancer treatment among healthcare professionals and the general population, researchers suggest several actions, including:
-Enhanced medical education on cardiotoxicity both in medical schools and in continuing medical education
-Multidisciplinary collaboration between specialties to improve the understanding of cardiotoxicity among clinicians and patients, as well as facilitate early detection and intervention
-Promotion and support of research initiatives focused on cardiotoxicity in cancer treatment
-Use of digital resources to provide clinicians with easy access to up-to-date information on cardiotoxicity
“Addressing obesity in cancer patients before starting chemotherapy, as well as considering the potential risk of cardiotoxicity, requires a comprehensive approach,” said Gaibor Santos. “Some strategies that clinicians may consider include pretreatment assessment, lifestyle interventions, and cardiovascular risk management. It is important to note that these strategies must be tailored to the specific needs of each patient and in accordance with current evidence-based guidelines.”
This study is presented at a congress organized by the ACC (American College of Cardiology) and the Costa Rican Association of Cardiology. (Source: American College of Cardiology)
#Breast #cancer #body #mass #index #chemotherapy