Cardiovascular disease: People who've had cancer may have higher risk

• Breast and blood cancer survivors could have a higher risk of developing cardiovascular disease.
• Researchers report that survivors of blood cancer had the highest risk and developed changes in the size and function of their heart.
• Breast cancer survivors also had an elevated risk of dying from cardiovascular disease.

Breast and blood cancer survivors might have an increased risk of cardiovascular disease, according to a study published today in the online journal Heart.

Researchers assessed the cardiovascular health of 18,714 UK Biobank participants with a previous diagnosis of cancer.

The breakdown on types of cancer was as follows:

• lung – 313
• breast – 9,531
• prostate – 3,291
• blood – 2,230
• uterine – 937
• colon – 2,412

The average age for the participants was 62 and about two-thirds were women.

The scientists matched the participants to control subjects based on age and traditional risk factors. The controls did not have a history of cancer.

Cardiovascular health of the participants and the controls was tracked for approximately 12 years.

Around one-third of the cancer survivors developed one or more of the following conditions:

• ischemic heart disease
• stroke
• atrial fibrillation
• heart failure
• non-ischemic cardiomyopathies
• blood clots in the veins, arteries, or lungs
• pericarditis

The risk of cardiovascular disease from cancer

New cardiovascular disease, including ischemic heart disease, atrial fibrillation, and heart disease developed in:

• 49% of lung cancer survivors
• 48% of blood cancer survivors
• 41% of prostate cancer survivors

Blood cancer survivors had a significantly higher risk of developing all cardiovascular diseases considered in the study. MRI scans also showed changes in the size and function of their hearts.

The researchers noted that people with blood cancer are typically exposed to chemotherapies that are harmful to the heart and radiotherapy that can damage the chest wall overlying the heart.

Breast cancer survivors had an elevated risk of developing and dying from heart failure and non-ischemic cardiomyopathies. They were also more likely to be diagnosed with pericarditis than the control group. MRI scans for this group were more likely to show functional heart change.

The highest risk of developing cardiovascular disease or complications is typically in the first year after a cancer diagnosis. Other than this study, there is little information known on the long-term risks of heart disease in cancer survivors. There are also a limited number of studies that use scans to determine if there is damage that has not yet resulted in symptoms.

The researchers say their study shows that people with blood or breast cancer could have the highest risk of developing cardiovascular disease of the cancer types they assessed.

During the monitoring period, 19% of the cancer survivors died, compared to 8% of the control group. Cardiovascular disease was the primary cause of death in 1 out of 12 deaths for the cancer survivors.

The study did have some limitations:

• It was observational and could not establish cause and effect.
• There was a small number of lung and uterine cancer survivors.
• They did not have information on cancer grade, stage, or treatments received.
• Most of the participants were white so it is unknown whether these findings would apply to people of other races and ethnic backgrounds.

Shared risk factors

The researchers noted that risk factors associated with cardiovascular disease were common in people with a cancer diagnosis.

These risk factors include:

• smoking
• high blood pressure
• excess weight

About one-tenth of participants with lung, uterine, and bowel cancer had diabetes. About 18% had preexisting cardiovascular disease.

A study published last year in the Journals of American College of Cardiology noted that cardiovascular disease and cancer had shared risk factors, including:

• smoking and other lifestyle factors
• diabetes
• obesity

However, the researchers in this study found that these risk factors alone do not account for the increased risk of cardiovascular disease seen in cancer survivors. They suggest that treatments for cancer, including radiation and systemic therapies, as well as the impact of cancer on the body (via inflammation or oxidative stress) may be associated with increased cardiovascular disease risk in this group.

They suggested that a combination of treatments and lifestyle factors contribute to the higher rates of heart disease.

Lowering the risk of cancer

According to the Centers for Disease Control and Prevention (CDC), there are things you can do to lower your risk of developing cancer and ways to help diagnose the disease early to increase the chances of survival.

Screening tests – There are many screening procedures and tests to find cancer. A mammogram looks for breast cancer, a colonoscopy looks for colon cancer. People at risk of lung cancer – as a smoker or former smoker – can have a lung cancer screening. A discussion with a medical professional on your lifestyle, family history, occupation, or other risk factors, can pinpoint which cancer screenings are best.

Vaccines – There are vaccines available that can lower your risk of developing some cancers. The human papillomavirus (HPV) vaccine helps prevent the HPV virus, which can cause cancers such as cervical cancer. The National Cancer Institute recommends children 11 or 12 years old should receive the vaccine. It is considered effective when given up until the 26. Ideally, girls should receive it before becoming sexually active.

The National Institutes of Health suggests not smoking, or quitting it you do, to lower your risk of cancer. In addition, adopting healthy habits, such as regular exercise, losing weight, and eating a healthy diet can reduce the risks. The American Institute of Cancer Research states that mostly plant-based diets, such as the Mediterranean diet, lead to less inflammation, which can in turn reduce your risk of cancer.

Lowering the risk of heart disease

Heart disease and cancer have many of the same risk factors, so lifestyle factors, such as regular exercise and a healthy plant-heavy diet, will also help prevent heart disease.

According to the American Heart Association, screening tests for heart disease include:

• Blood tests to measure your cholesterol – there are lifestyle factors and medications that can help in managing cholesterol levels.
• Blood tests to measure blood glucose – high blood glucose can lead to prediabetes and type 2 diabetes, which increase the risk of cardiovascular disease.
• Blood pressure – blood pressure is typically checked at regular health care visits. A blood pressure less than 120/80 is considered healthy.
• Body mass index and waist circumference – health care professionals can evaluate your risk of heart disease based on BMI and waist circumference. For most adults, a BMI of 18.5 to 24.9 is considered healthy; 25 to 29.9 is considered overweight, and 30 and above is considered obese.

Not smoking, eating right, and regular exercise are keys to healthy living.

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