Ionizing radiation-induced circulatory and metabolic diseases

Abstract

Risks to health are the prime consideration in all human situations of ionizing radiation exposure and therefore of relevance to radiation protection in all occupational, medical, and public exposure situations. Over the past few decades, advances in therapeutic strategies have led to significant improvements in cancer survival rates. However, a wide range of long-term complications have been reported in cancer survivors, in particular circulatory diseases and their major risk factors, metabolic diseases. However, at lower levels of exposure, the evidence is less clear. Under real-life exposure scenarios, including radiotherapy, radiation effects in the whole organism will be determined mainly by the response of normal tissues receiving relatively low doses, and will be mediated and moderated by systemic effects. Therefore, there is an urgent need for further research on the impact of low-dose radiation. In this article, we review radiation-associated risks of circulatory and metabolic diseases in clinical, occupational or environmental exposure situations, addressing epidemiological, biological, risk modelling, and systems biology aspects, highlight the gaps in knowledge and discuss future directions to address these gaps.

Keywords: Circulatory disease; Endothelial; Heart; Ionizing radiation; Metabolic syndrome; Radiotherapy; Systems biology.

Figure 1.. A model of early plaque development.

A first fatty streak appears after time Δa₀ with area F₁ = s. Subsequently it expands with growth rate γ₁. At the last depicted time point, part of the fatty streak has become a fibrous plaque, with area F₂ = s. The intimal surface area involved with fatty streaks (and more advanced lesions), F1, results from further growth of the first fatty streak and from the origin of a second fatty streak (Simonetto et al. 2020b).

Figure 2.

Schematic representation of the components, interrelations and timing of a network of adverse outcome pathways and key events contributing to the development of adverse health outcome: circulatory and metabolic diseases.