Recent studies from the VCU Massey Comprehensive Cancer Center and VCU Health Pauley Heart Center have unveiled that individuals who have survived cancer during childhood face a substantially increased risk of death after experiencing major cardiovascular incidents such as heart failure, heart attacks, or strokes, compared to the general population.
Published in the Journal of the American College of Cardiology, these insights suggest a need for a fundamental change in the clinical approach to heart health, advocating for the consideration of cardiovascular risk factors at a younger age among childhood cancer survivors.
The research reveals a startling comparison: a 50-year-old from the general population faces a similar risk of death following a major cardiovascular event as a 30-year-old who had been treated for cancer in childhood. Wendy Bottinor, M.D., the lead author of the study and a cardio-oncologist at both Massey and the Pauley Heart Center, highlighted the amplified impact of untreated risk factors on the mortality risk after severe heart events in childhood cancer survivors compared to their counterparts in the general population. That challenges the assumption that youth automatically diminishes the need to treat risk factors such as high blood pressure or cholesterol.
Building on previous findings that childhood cancer survivors are at an increased risk of heart disease and cardiovascular mortality, this study delves deeper into how these early-life cancers affect survivors’ mortality risks from major cardiovascular events later in life, in contrast to individuals without a cancer history.
The researchers relied on comprehensive data from the Childhood Cancer Survivors Study, which comprises a cohort of 25,000 childhood cancer survivors and their siblings, and the CARDIA study, a diverse cardiology database focused on the development of heart disease in young adults. Their findings indicate that childhood cancer survivors experience higher mortality rates following heart failure, heart attack, or stroke than their siblings without a cancer history and that they are significantly younger than the general population when these events occur.
This phenomenon suggests an “accelerated ageing” effect in childhood cancer survivors, wherein their medical profiles resemble those of significantly older individuals. The study also explored potential interventions, identifying dyslipidemia—an imbalance of fats in the blood—as a condition that, when treated with statins, could lower the mortality risk post-cardiovascular event. Statins, which reduce cholesterol levels and inflammation, may offer protective benefits against heart disease and cancer.
Furthermore, the research underscores the heightened risk of heart-related deaths associated with hypertension among childhood cancer survivors. This finding calls for reevaluating current medical guidelines, often setting high thresholds for prescribing blood pressure medication, especially for younger patients.
Dr Bottinor advocates for a lower threshold for treating hypertension in childhood cancer survivors, given their elevated risk of heart disease. She emphasizes the necessity for further research to fully understand the impact of heart health risk factors in young adults treated for cancer, the potential benefits of modifying these risk factors, and the importance of raising awareness about the cardiovascular risks following cancer treatment in children and young adults.
Cardio-oncology development as a field aims to provide specialized, multidisciplinary heart care throughout the cancer treatment process to minimize cardiovascular health repercussions. The cardio-oncology program at Massey and the Pauley Heart Center stands out as the sole program in Virginia recognized as a Center of Excellence by the International Cardio-Oncology Society.
More information: Wendy Bottinor et al, Mortality After Major Cardiovascular Events in Survivors of Childhood Cancer, Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2023.12.022
Journal information: Journal of the American College of Cardiology Provided by Virginia Commonwealth University
