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AHA statement supports vascular cardio-oncology

Feb. 21, 2019, 10:16 AM

 

by Tom Wilemon

The American Heart Association (AHA) has issued a scientific statement calling for the integration of cardio-oncology and vascular medicine to provide cancer patients and cancer survivors with optimal cardiovascular care.

Additionally, the statement provides a blueprint for research needs in this new field of “vascular cardio-oncology.”

The statement, published Feb. 21 in Circulation, is largely based on contributions from Vanderbilt University Medical Center. The authors of the scientific statement include Vanderbilt physicians Javid Moslehi, MD, Joshua Beckman MD, and David Chism, MD.

Javid Moslehi, MD

Beckman, who served as chair of the American Heart Association Council on Peripheral Vascular Disease, recommended that the organization issue the scientific statement.

“The field of cardio-oncology has been developing over the last decade,” said Beckman. “It has been recognized that the therapies applied to cancer can affect the cardiovascular system. In the beginning, there was a lot more emphasis put on heart-related outcomes, particularly heart failure, rhythm disturbances and sometimes electrical abnormalities. But what has really been going on as well — and I really don’t think it has had as much play until recently — is the second half of that word: vascular.”

Joshua Beckman, MD, MSc

The statement noted: “Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation.” A team of Vanderbilt researchers, for example, recently reported in The Lancet Oncology the occurrence of vascular complications, including vasculitis, after treatment with immune checkpoint inhibitors, which harness a patient’s immune system to fight cancer.

However, more traditional cancer treatments, including chemotherapy, can also cause cardiovascular complications.

“Many of the problems that initially rose from cancer therapies were myocardial, meaning the heart would stop working well,” said Moslehi, vice chair of the committee that issued the statement.

“It was true with doxyrubicin, one of the older medications, and true with trastuzumab. There were more myocardial issues so traditionally many of the physicians taking care of these patients were heart failure specialists. But now we are beginning to see a lot of vascular complications, especially with newer therapies and as more patients survive cancer. This necessitates new collaborations.”

The scientific statement from the AHA includes a summary of vascular toxicities of both traditional and novel cancer therapies by treatment categories. It also provides advice on how to structure a cardio-oncology service and defines new research questions in this space. Vanderbilt researchers have already joined forces in answering some of these questions. Moslehi, Beckman and other colleagues, for example, recently received a National Institutes of Health grant to study the vascular and hypertensive effects of angiogenesis inhibitors.

“Having a document that comes from the American Heart Association shines a light over a topic that few other organizations can provide,” Beckman said. “I think it will increase attention to these problems from people who pay for research and, most probably, for physicians who will consider training in this area. I think this document will be a beacon.” 

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