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Cancer patients face increased risk of heart disease

Dr. Zhang attending to patients at the Uganda Heart Institute (PHOTO/Courtesy)

Dr. Zhang attending to patients at the Uganda Heart Institute (PHOTO/Courtesy)

Results from a baseline study conducted among cancer patients at the Uganda Cancer Institute (UCI) have identified an aspect of cancer that requires enormous attention – the risk of cardiovascular diseases (CVDs). CVDs are a set of conditions that affect the heart and blood vessels such as stroke and coronary heart disease. The 15-months study dubbed: ‘Detecting Subclinical Anthracycline Related Cardiac Dysfunction in Low-Income Countries’ (SATRACD) aimed to investigate individuals at risk of developing heart disease after undergoing cancer chemotherapy. It is the first of its kind to be done in Uganda and it was a collaboration between Makerere, UCI, and the Uganda Heart Institute (UHI).

SATRACD was conducted among 355 patients who were scheduled to receive anthracycline therapy (use of a certain class of drugs in cancer chemotherapy). Female patients and patients with breast cancer accounted for the majority of patients studied.

Hypertension, obesity, and HIV were identified as leading risk factors for CVDs among study participants. Patients who took part in the study had different types of cancer including: breast cancer, lymphomas, sarcoma, leukemia, and liver cancer. These patients were examined for heart disease immediately before and six months after receiving chemotherapy. Although hypertension was the most prevalent risk factor at 27%, it was not directly linked to any cancer. Conversely, HIV and obesity which respectively accounted for 18% and 12% of the heart disease risk factors were directly found to cause some cancers.

“While obesity has been a traditional risk factor for heart disease, we are now seeing that it is strongly associated with cancer and breast cancer, both cancers have been recognized as obesity-associated cancers. About 54% of breast cancer patients in Uganda are either overweight or obese,” Dr. Wanzhu Zhang, the lead researcher, and Cardiologist at Uganda Heart Institute (UHI) said in an interview.

More interestingly, obesity prevalence was strikingly higher among cancer patients than in the local population. Moreover, HIV-associated inflammation was identified as a major onset of cardiovascular risk, causing abnormal heart rhythms and even heart failure. Other risk factors identified included: alcohol use (20%); anemia (17%); smoking (1.1%); Diabetes (0.3%) and Chronic Kidney Disease (0.3%).

These findings show that a large proportion of cancer patients are at risk of developing heart problems such as blocked arteries and damage to small blood vessels if the risk factors are not quickly addressed. As long-term survival rates for cancer patients improve due to advancements in treatment, Dr. Zhang says it is critical to tackle heart disease risk factors such as hypertension that may become significant years later.

“The high prevalence of cardiovascular risk factors among cancer patients calls for earlier, more aggressive, and better coordinated cardiovascular care. Knowing the CVD risks is the first step to improving cardiac care of cancer patients,” she cautioned.

Dr. Zhang examining a patient's records at the Uganda Heart Institute

Dr. Zhang examining a patient’s records at the Uganda Heart Institute

Cancer Treatment & Heart Disease

The second part of the study sought to identify the impact of anthracycline therapy on heart function. It revealed that the use of this type of cancer medication poses dangerous heart problems to cancer patients because it not only affects the heart function directly but also weakens the ability of the heart to adapt to other ‘stressors’ later in the life, for example, a major operation, pregnancy, and chest radiotherapy. Dr. Zhang notes that clinicians should closely monitor the heart function of cancer patients before and after chemotherapy.

On an individual basis, preventive strategies include regular medical check-ups of blood pressure, diabetes, and obesity; eating a healthy diet, and regular mild exercise.

Study Recommendations

Owing to the high prevalence of cardiovascular risk factors among cancer patients in Uganda, the study recommends the promotion of cardio-oncology practice, a new medical discipline that focuses on the detection, monitoring, and treatment of cardiovascular disease occurring as a side effect of chemotherapy and chest radiotherapy.

Additionally, there is a need for health facilities to institute regular heart check-ups of cancer patients in order to detect heart problems early.

This research was supported by the NURTURE Research Training and Mentoring Program for Career Development at Makerere University’s College of Health Sciences (D43TW010132).

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