Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.07.008
Elena Wadden MD , Alexi Vasbinder PhD, RN , Vidhushei Yogeswaran MD , Aladdin H. Shadyab PhD , Nazmus Saquib MBBS, MPH, PhD , Yangbo Sun PhD , Lisa Warsinger Martin MD , Ramesh Mazhari MD , JoAnn E. Manson MD, DrPH , Marcia Stefanick PhD , Ana Barac MD, PhD , Michael S. Simon MD , Kerryn Reding PhD, MPH, RN , Richard K. Cheng MD, MS
Background
Relationships between lifestyle risk factors and cardiovascular disease (CVD) risk in women with breast cancer (BC) are underexplored.
Objectives
To evaluate the incidence of CVD in relation to the Life’s Essential 8 (LE8) score among women with BC.
Methods
Data from the Women’s Health Initiative were utilized. The primary exposure was the LE8 score assessed prior to BC diagnosis. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). The primary endpoint was a composite of incident CVD events, which included coronary heart disease, defined as myocardial infarction along with coronary revascularization, CVD death, and stroke. We calculated the cumulative incidence of CVD and estimated hazard ratios.
Results
Among 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% CI: 0.46-0.69) for moderate CVH and 0.34 (95% CI: 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD.
Conclusions
Higher LE8 scores were associated with a lower risk of incident CVD among women with BC in the United States.
{"title":"Life’s Essential 8 and Incident Cardiovascular Disease in U.S. Women With Breast Cancer","authors":"Elena Wadden MD , Alexi Vasbinder PhD, RN , Vidhushei Yogeswaran MD , Aladdin H. Shadyab PhD , Nazmus Saquib MBBS, MPH, PhD , Yangbo Sun PhD , Lisa Warsinger Martin MD , Ramesh Mazhari MD , JoAnn E. Manson MD, DrPH , Marcia Stefanick PhD , Ana Barac MD, PhD , Michael S. Simon MD , Kerryn Reding PhD, MPH, RN , Richard K. Cheng MD, MS","doi":"10.1016/j.jaccao.2024.07.008","DOIUrl":"10.1016/j.jaccao.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Relationships between lifestyle risk factors and cardiovascular disease (CVD) risk in women with breast cancer (BC) are underexplored.</div></div><div><h3>Objectives</h3><div>To evaluate the incidence of CVD in relation to the Life’s Essential 8 (LE8) score among women with BC.</div></div><div><h3>Methods</h3><div>Data from the Women’s Health Initiative were utilized. The primary exposure was the LE8 score assessed prior to BC diagnosis. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). The primary endpoint was a composite of incident CVD events, which included coronary heart disease, defined as myocardial infarction along with coronary revascularization, CVD death, and stroke. We calculated the cumulative incidence of CVD and estimated hazard ratios.</div></div><div><h3>Results</h3><div>Among 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% CI: 0.46-0.69) for moderate CVH and 0.34 (95% CI: 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD.</div></div><div><h3>Conclusions</h3><div>Higher LE8 scores were associated with a lower risk of incident CVD among women with BC in the United States.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 746-757"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.08.003
Tochi M. Okwuosa DO , Donald Lloyd-Jones MD
{"title":"Measuring “Cardiovascular Health” in Everyone Including Cancer Patients","authors":"Tochi M. Okwuosa DO , Donald Lloyd-Jones MD","doi":"10.1016/j.jaccao.2024.08.003","DOIUrl":"10.1016/j.jaccao.2024.08.003","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 758-760"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.04.010
Cheng Hwee Soh PhD , RuiDong Xiang PhD , Fumihiko Takeuchi PhD , Thomas H. Marwick MBBS, PhD, MPH
Background
The risk for heart failure (HF) is increased among cancer survivors, but predicting individual HF risk is difficult. Polygenic risk scores (PRS) for HF prediction summarize the combined effects of multiple genetic variants specific to the individual.
Objectives
The aim of this study was to compare clinical HF prediction models with PRS in both cancer and noncancer populations.
Methods
Cancer and HF diagnoses were identified using International Classification of Diseases-10th Revision codes. HF risk was calculated using the ARIC (Atherosclerosis Risk in Communities) HF score (ARIC-HF). The PRS for HF (PRS-HF) was calculated according to the Global Biobank Meta-analysis Initiative. The predictive performance of the ARIC-HF and PRS-HF was compared using the area under the curve (AUC) in both cancer and noncancer populations.
Results
After excluding 2,644 participants with HF prior to consent, 440,813 participants without cancer (mean age 57 years, 53% women) and 43,720 cancer survivors (mean age 60 years, 65% women) were identified at baseline. Both the ARIC-HF and PRS-HF were significant predictors of incident HF after adjustment for chronic kidney disease, overall health rating, and total cholesterol. The PRS-HF performed poorly in predicting HF among cancer (AUC: 0.552; 95% CI: 0.539-0.564) and noncancer (AUC: 0.561; 95% CI: 0.556-0.566) populations. However, the ARIC-HF predicted incident HF in the noncancer population (AUC: 0.804; 95% CI: 0.800-0.808) and provided acceptable performance among cancer survivors (AUC: 0.748; 95% CI: 0.737-0.758).
Conclusions
The prediction of HF on the basis of conventional risk factors using the ARIC-HF score is superior compared to the PRS, in cancer survivors, and especially among the noncancer population.
{"title":"Use of Polygenic Risk Score for Prediction of Heart Failure in Cancer Survivors","authors":"Cheng Hwee Soh PhD , RuiDong Xiang PhD , Fumihiko Takeuchi PhD , Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.jaccao.2024.04.010","DOIUrl":"10.1016/j.jaccao.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><div>The risk for heart failure (HF) is increased among cancer survivors, but predicting individual HF risk is difficult. Polygenic risk scores (PRS) for HF prediction summarize the combined effects of multiple genetic variants specific to the individual.</div></div><div><h3>Objectives</h3><div>The aim of this study was to compare clinical HF prediction models with PRS in both cancer and noncancer populations.</div></div><div><h3>Methods</h3><div>Cancer and HF diagnoses were identified using International Classification of Diseases-10th Revision codes. HF risk was calculated using the ARIC (Atherosclerosis Risk in Communities) HF score (ARIC-HF). The PRS for HF (PRS-HF) was calculated according to the Global Biobank Meta-analysis Initiative. The predictive performance of the ARIC-HF and PRS-HF was compared using the area under the curve (AUC) in both cancer and noncancer populations.</div></div><div><h3>Results</h3><div>After excluding 2,644 participants with HF prior to consent, 440,813 participants without cancer (mean age 57 years, 53% women) and 43,720 cancer survivors (mean age 60 years, 65% women) were identified at baseline. Both the ARIC-HF and PRS-HF were significant predictors of incident HF after adjustment for chronic kidney disease, overall health rating, and total cholesterol. The PRS-HF performed poorly in predicting HF among cancer (AUC: 0.552; 95% CI: 0.539-0.564) and noncancer (AUC: 0.561; 95% CI: 0.556-0.566) populations. However, the ARIC-HF predicted incident HF in the noncancer population (AUC: 0.804; 95% CI: 0.800-0.808) and provided acceptable performance among cancer survivors (AUC: 0.748; 95% CI: 0.737-0.758).</div></div><div><h3>Conclusions</h3><div>The prediction of HF on the basis of conventional risk factors using the ARIC-HF score is superior compared to the PRS, in cancer survivors, and especially among the noncancer population.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 714-727"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.08.004
Jie Lee MD, PhD , Jhen-Bin Lin MD
{"title":"Body Composition During Androgen Deprivation Therapy in Prostate Cancer","authors":"Jie Lee MD, PhD , Jhen-Bin Lin MD","doi":"10.1016/j.jaccao.2024.08.004","DOIUrl":"10.1016/j.jaccao.2024.08.004","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 772-774"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.07.016
Massimiliano Camilli MD , Carlo Maria Cipolla MD , Susan Dent MD, BSc , Giorgio Minotti MD, PhD , Daniela Maria Cardinale MD, PhD
Since their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area.
{"title":"Anthracycline Cardiotoxicity in Adult Cancer Patients","authors":"Massimiliano Camilli MD , Carlo Maria Cipolla MD , Susan Dent MD, BSc , Giorgio Minotti MD, PhD , Daniela Maria Cardinale MD, PhD","doi":"10.1016/j.jaccao.2024.07.016","DOIUrl":"10.1016/j.jaccao.2024.07.016","url":null,"abstract":"<div><div>Since their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 655-677"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.07.001
Ana Barac MD, PhD , Raymond C. Wadlow MD , John F. Deeken MD , Christopher deFilippi MD
{"title":"Cardiac Troponin I and T in ICI Myocarditis Screening, Diagnosis, and Prognosis","authors":"Ana Barac MD, PhD , Raymond C. Wadlow MD , John F. Deeken MD , Christopher deFilippi MD","doi":"10.1016/j.jaccao.2024.07.001","DOIUrl":"10.1016/j.jaccao.2024.07.001","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 804-807"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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