In an interview at this year’s American Heart Association Scientific Sessions meeting in Chicago, Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical Center, discussed the importance of addressing cardiovascular disease (CVD) prevention in patients with cancer who are undergoing treatment.
The Pooled Cohort Equation may be good at predicting risk in the general population, but patients with cancer have additional cardiovascular disease risk factors that include radiation, type and stage of cancer, and treatment history, such as an anthracycline or capecitabine, explained Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical Center, in an interview during this year’s American Heart Association (AHA) Scientific Sessions meeting in Chicago.
Do cardiac disease types and the severity of those diseases differ between patients with cancer and the general population?
Yes, they do. One of the presentations I gave, the Pooled Cohort Equation was a sort of guideline-developed method to assess cardiovascular risk that was led by our former AHA President Donald Jones, [MD, ScM, FAHA]. In this equation, you have age, race, sex, the cholesterol levels—so the LDL [low-density lipoprotein], or bad cholesterol, and HDL [high-density lipoprotein], or good cholesterol levels—whether they smoke or not, whether they have diabetes or not, blood pressure, and you put all of these factors into the equation and it gives you a number that gives you a sense of the 10-year risk of cardiovascular events in this particular patient.
Well, the Pooled Cohort Equation is good for the general population, but when it comes to the cancer patient, then you have to add, did they get medicinal radiation or not? You have to add did they get an anthracycline or not. You have to add what's the kind of cancer, what stage of cancer, what other sort of cancer treatments have they received other than anthracycline. So tyrosine kinase inhibitors or cisplatin or immune checkpoint inhibitors or capecitabine. What other sorts of treatments have they received? If you plug all of that into the equation, the risks are higher.
There have been a lot of risk prediction tools for cancer patients in terms of cardiovascular events, but none of them has been great enough to for us to fully adopt. We know that we do have cardio-oncology guidelines that came out recently, but there’s still on a lot that's missing because we still need more research in this field. It's a new field in cardiology. We're still learning a lot about cancer treatment and the way it affects the heart. But the risk is definitely beyond that that we typically see in the general population. There's no doubt about that.