Pub Date : 2025-12-01DOI: 10.1016/j.jaccao.2025.07.011
Hari S. Raman MD, MBA , Joshua Mitchell MD, MSCI , Anju Nohria MD, MSc , Jenica N. Upshaw MD , Ann S. LaCasce MD, MMSc
Classic Hodgkin lymphoma is a highly curable lymphoma that affects primarily younger patients. The therapeutic landscape has evolved and generally consists of varying combinations of chemotherapy and immunotherapy as well as radiation in selected cases. Although most patients are cured of their lymphoma, there is a risk for late treatment-related cardiotoxicity that affects long-term survival and quality of life in this population. Careful consideration of baseline cardiac function and risk factors should be undertaken prior to proceeding with anthracycline-based therapies or thoracic radiation, as adjuvant cardiac-focused efforts may serve to mitigate the risk for cardiovascular dysfunction in this population. This review outlines the evidence supporting current recommendations for assessing baseline cardiotoxicity risk, implementing risk reduction strategies and treatment modifications, the role of multidisciplinary evaluation in high-risk patients, and strategies for long-term cardiac monitoring to minimize treatment-related cardiac morbidity and mortality.
{"title":"Cardiovascular and Oncologic Considerations in Adult Hodgkin Lymphoma","authors":"Hari S. Raman MD, MBA , Joshua Mitchell MD, MSCI , Anju Nohria MD, MSc , Jenica N. Upshaw MD , Ann S. LaCasce MD, MMSc","doi":"10.1016/j.jaccao.2025.07.011","DOIUrl":"10.1016/j.jaccao.2025.07.011","url":null,"abstract":"<div><div>Classic Hodgkin lymphoma is a highly curable lymphoma that affects primarily younger patients. The therapeutic landscape has evolved and generally consists of varying combinations of chemotherapy and immunotherapy as well as radiation in selected cases. Although most patients are cured of their lymphoma, there is a risk for late treatment-related cardiotoxicity that affects long-term survival and quality of life in this population. Careful consideration of baseline cardiac function and risk factors should be undertaken prior to proceeding with anthracycline-based therapies or thoracic radiation, as adjuvant cardiac-focused efforts may serve to mitigate the risk for cardiovascular dysfunction in this population. This review outlines the evidence supporting current recommendations for assessing baseline cardiotoxicity risk, implementing risk reduction strategies and treatment modifications, the role of multidisciplinary evaluation in high-risk patients, and strategies for long-term cardiac monitoring to minimize treatment-related cardiac morbidity and mortality.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 7","pages":"Pages 781-799"},"PeriodicalIF":12.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaccao.2025.09.002
Ninad Oak PhD , Jose Alberto Navarro-Garcia PhD , Minhua Li BA , Mara R. Turkieltaub Paredes BS , Satadru K. Lahiri PhD , Bharat K. Kantharia MD , Daisuke Nakada PhD , Xander H.T. Wehrens MD, PhD , Mohit M. Hulsurkar PhD
{"title":"Acute Myeloid Leukemia Drives Atrial Fibrillation Through TNFα Signaling Activation","authors":"Ninad Oak PhD , Jose Alberto Navarro-Garcia PhD , Minhua Li BA , Mara R. Turkieltaub Paredes BS , Satadru K. Lahiri PhD , Bharat K. Kantharia MD , Daisuke Nakada PhD , Xander H.T. Wehrens MD, PhD , Mohit M. Hulsurkar PhD","doi":"10.1016/j.jaccao.2025.09.002","DOIUrl":"10.1016/j.jaccao.2025.09.002","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 7","pages":"Pages 890-893"},"PeriodicalIF":12.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaccao.2025.09.005
Daniel S. Lefler MD , Elise F. Nassif Haddad MD, MS , Anju Nohria MD, MSc , Mark Agulnik MD , Jacquelyn Crane MD , Michael G. Fradley MD
Sarcomas are a heterogeneous group of connective tissue tumors that can occur at any anatomical site. This includes the heart and great vessels, where angiosarcoma, leiomyosarcoma, intimal sarcoma, and undifferentiated sarcomas are the dominant histologic subtypes. These presentations are as complex as treatment planning, which often requires a multimodality approach. For these tumors, as well as sarcomas in other sites, multiple treatments carry risks of cardiotoxicity. Crucially, treatment universally includes high cumulative doses of anthracyclines, requiring risk modification using dexrazoxane, infusional administration, or liposomal formulations. Furthermore, multiple other therapies for sarcoma are associated with cardiovascular side effects. This review highlights the unique aspects of care for cardiac sarcomas, cardiovascular considerations of systemic agents used to treat sarcoma, the pediatric sarcoma population, and how cardiac surveillance of sarcoma patients can be approached.
{"title":"Sarcoma: Cardiovascular and Oncologic Considerations","authors":"Daniel S. Lefler MD , Elise F. Nassif Haddad MD, MS , Anju Nohria MD, MSc , Mark Agulnik MD , Jacquelyn Crane MD , Michael G. Fradley MD","doi":"10.1016/j.jaccao.2025.09.005","DOIUrl":"10.1016/j.jaccao.2025.09.005","url":null,"abstract":"<div><div>Sarcomas are a heterogeneous group of connective tissue tumors that can occur at any anatomical site. This includes the heart and great vessels, where angiosarcoma, leiomyosarcoma, intimal sarcoma, and undifferentiated sarcomas are the dominant histologic subtypes. These presentations are as complex as treatment planning, which often requires a multimodality approach. For these tumors, as well as sarcomas in other sites, multiple treatments carry risks of cardiotoxicity. Crucially, treatment universally includes high cumulative doses of anthracyclines, requiring risk modification using dexrazoxane, infusional administration, or liposomal formulations. Furthermore, multiple other therapies for sarcoma are associated with cardiovascular side effects. This review highlights the unique aspects of care for cardiac sarcomas, cardiovascular considerations of systemic agents used to treat sarcoma, the pediatric sarcoma population, and how cardiac surveillance of sarcoma patients can be approached.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 7","pages":"Pages 800-815"},"PeriodicalIF":12.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jaccao.2025.05.009
Theodorus W. Kouwenberg MD , Elvira C. van Dalen MD, PhD , Renée L. Mulder PhD , Saro Armenian DO, MPH , Elizabeth A.M. Feijen PhD , Eric J. Chow MD, MPH , Helen Kosmidis MD, PhD , Britta J. Vormoor-Bürger MD, DrMed , Chikako Kiyotani MD, PhD , Paul C. Nathan MD, MSc , Livia Kapusta MD, PhD , Heynric B. Grotenhuis MD, PhD , Frederike K. Engels PhD , Arco J. Teske MD, PhD , Athanasios Tragiannidis MD, PhD , Martijn G. Slieker MD, PhD , Shuichi Ozono MD, PhD , Anju Nohria MD, MSc , Tomáš Sláma MD, PhD , Roderick Skinner MB, ChB , Annelies M.C. Mavinkurve-Groothuis MD, PhD
Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.
{"title":"IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood Cancer","authors":"Theodorus W. Kouwenberg MD , Elvira C. van Dalen MD, PhD , Renée L. Mulder PhD , Saro Armenian DO, MPH , Elizabeth A.M. Feijen PhD , Eric J. Chow MD, MPH , Helen Kosmidis MD, PhD , Britta J. Vormoor-Bürger MD, DrMed , Chikako Kiyotani MD, PhD , Paul C. Nathan MD, MSc , Livia Kapusta MD, PhD , Heynric B. Grotenhuis MD, PhD , Frederike K. Engels PhD , Arco J. Teske MD, PhD , Athanasios Tragiannidis MD, PhD , Martijn G. Slieker MD, PhD , Shuichi Ozono MD, PhD , Anju Nohria MD, MSc , Tomáš Sláma MD, PhD , Roderick Skinner MB, ChB , Annelies M.C. Mavinkurve-Groothuis MD, PhD","doi":"10.1016/j.jaccao.2025.05.009","DOIUrl":"10.1016/j.jaccao.2025.05.009","url":null,"abstract":"<div><div>Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 6","pages":"Pages 683-690"},"PeriodicalIF":12.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jaccao.2025.07.008
Sarah C. Hull MD, MBE , Reed Mszar MPH, MS , Robert J. Ostfeld MD, MSc , Leah M. Ferrucci PhD, MPH , Lorelei A. Mucci ScD, MPH , Edward Giovannucci MD, ScD , Stacy Loeb MD, MSc, PhD (Hon)
Cardiovascular disease (CVD) and cancer remain the leading causes of mortality in the United States, where poor diet has surpassed smoking as the leading risk factor for death, and life expectancy has hit a plateau as CVD mortality has stagnated over the past decade. Although the pathophysiology of CVD and cancer is complex and multifactorial, lifestyle factors including diet often contribute significantly to their pathogenesis. There is a wealth of observational data as well as emerging trial data supporting the benefits of a predominantly whole-food plant-based diet in the prevention of CVD and cancer. However, there is a need for implementation science to effectuate existing knowledge. Given the shortcomings of the standard American diet, characterized by excessive intake of red meat and ultraprocessed foods, while deficient in fiber and phytonutrients, it will be necessary to shift default patterns of eating to make healthy choices the path of least resistance.
{"title":"Diet and Prevention of Cardiovascular Disease and Cancer","authors":"Sarah C. Hull MD, MBE , Reed Mszar MPH, MS , Robert J. Ostfeld MD, MSc , Leah M. Ferrucci PhD, MPH , Lorelei A. Mucci ScD, MPH , Edward Giovannucci MD, ScD , Stacy Loeb MD, MSc, PhD (Hon)","doi":"10.1016/j.jaccao.2025.07.008","DOIUrl":"10.1016/j.jaccao.2025.07.008","url":null,"abstract":"<div><div>Cardiovascular disease (CVD) and cancer remain the leading causes of mortality in the United States, where poor diet has surpassed smoking as the leading risk factor for death, and life expectancy has hit a plateau as CVD mortality has stagnated over the past decade. Although the pathophysiology of CVD and cancer is complex and multifactorial, lifestyle factors including diet often contribute significantly to their pathogenesis. There is a wealth of observational data as well as emerging trial data supporting the benefits of a predominantly whole-food plant-based diet in the prevention of CVD and cancer. However, there is a need for implementation science to effectuate existing knowledge. Given the shortcomings of the standard American diet, characterized by excessive intake of red meat and ultraprocessed foods, while deficient in fiber and phytonutrients, it will be necessary to shift default patterns of eating to make healthy choices the path of least resistance.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 6","pages":"Pages 649-667"},"PeriodicalIF":12.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jaccao.2025.06.007
Nazanin Aghel MD, MSc , Jeffrey Howard Lipton MD, PhD
Cardiovascular (CV) disease and risk factors are notably prevalent among patients with chronic myeloid leukemia (CML). The introduction of BCR::ABL1 tyrosine kinase inhibitors has significantly transformed the treatment paradigm for CML. However, it is imperative to recognize that these therapeutic agents may lead to CV side effects. For instance, dasatinib has been associated with the development of pulmonary arterial hypertension, while nilotinib and ponatinib have been linked to various vascular complications. To accurately evaluate the incidence of CV events associated with CML treatment, systematic documentation of these occurrences in future clinical trials is essential. This approach will facilitate a deeper understanding of the CV implications of tyrosine kinase inhibitor therapy in patients with CML.
{"title":"Cardiovascular Disease in Patients With Chronic Myeloid Leukemia","authors":"Nazanin Aghel MD, MSc , Jeffrey Howard Lipton MD, PhD","doi":"10.1016/j.jaccao.2025.06.007","DOIUrl":"10.1016/j.jaccao.2025.06.007","url":null,"abstract":"<div><div>Cardiovascular (CV) disease and risk factors are notably prevalent among patients with chronic myeloid leukemia (CML). The introduction of <em>BCR::ABL1</em> tyrosine kinase inhibitors has significantly transformed the treatment paradigm for CML. However, it is imperative to recognize that these therapeutic agents may lead to CV side effects. For instance, dasatinib has been associated with the development of pulmonary arterial hypertension, while nilotinib and ponatinib have been linked to various vascular complications. To accurately evaluate the incidence of CV events associated with CML treatment, systematic documentation of these occurrences in future clinical trials is essential. This approach will facilitate a deeper understanding of the CV implications of tyrosine kinase inhibitor therapy in patients with CML.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"7 6","pages":"Pages 668-682"},"PeriodicalIF":12.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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