Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun;24(6):443-456.
doi: 10.1007/s11883-022-01021-x. Epub 2022 Apr 19.

Next Generation Risk Markers in Preventive Cardio-oncology

Morgan Lamberg  1 , Andrea Rossman  2 , Alexandra Bennett  2 , Sabrina Painter  3 , Rachel Goodman  1 , James MacLeod  2 , Ragasnehith Maddula  2 , David Rayan  1 , Krishna Doshi  4 , Alexander Bick  5 , Simone Bailey  6 , Sherry-Ann Brown  7
Affiliations
Review

Next Generation Risk Markers in Preventive Cardio-oncology

Morgan Lamberg et al. Curr Atheroscler Rep. 2022 Jun.

Abstract

Purpose of review: Cardiovascular disease (CVD) and cancer are the first and second most common causes of death within the USA. It is well established that a diagnosis of cancer increases risk and predisposes the patient to CVD, and vice versa. Despite these associations, cancer is not yet incorporated into current CVD risk calculators, necessitating additional CV risk markers for improved stratification in this at-risk population. In this review, we consider the utility of breast arterial calcification (BAC), coronary artery calcification (CAC), clonal hematopoiesis of indeterminate potential (CHIP), and cancer and cancer treatment in CVD risk assessment.

Recent findings: There is evidence supporting the use of BAC, CAC, CHIP, and cancer and cancer treatment for improved CV risk stratification in patients with cancer and those who are being screened for cancer. BAC has been shown to predict CAC, coronary atherosclerotic plaque on coronary CTA, coronary artery stenosis on coronary angiography, and CVD events and accordingly enhances CVD risk stratification beyond the atherosclerotic CVD (ASCVD) risk pooled cohort equation. Additionally, CAC visualized on CT utilized for lung cancer screening, radiation planning, and cancer staging is predictive of coronary artery disease (CAD). Furthermore, CHIP can also be utilized in risk stratification, as the presence of CHIP carries a 40% increase in CV risk independent of traditional CV risk factors. Finally, cancer and many oncologic therapies confer a lifelong increased risk of CVD. We propose an emerging set of tools to be incorporated into the routine continuum of CVD risk assessment in individuals who have been treated for cancer or who are being screened for cancer development. In this review, we discuss BAC, CAC, CHIP, and cancer and cancer treatment as emerging risk markers in cardiovascular health assessment. Their effectiveness in predicting and influencing the burden of CVD will be discussed, along with suggestions on their incorporation into preventive cardio-oncology practice. Future research will focus on short- and long-term CVD outcomes in these populations.

Keywords: Breast arterial calcification; Cancer; Cardio-oncology; Clonal hematopoiesis of indeterminate potential; Coronary artery calcification; Prevention; Risk.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Rachel Goodman reports the following: owning stock in Pfizer and Viatris; having investments in mutual funds that may or may not have stock in healthcare-related companies; she is a class B nonvoting member in a family LLC that may or may not have stock or mutual fund investments in healthcare-related companies, but she has no authority to buy or sell stocks, have no decision making authority of any kind, and have no knowledge of any investments made or sold in this family LLC. James MacLeod is co-president of the Medical College of Wisconsin Student Surgical Society. Alexander Bick reports the following: consulting fees from TenSixteen Bio to him. He also owns TenSixteen Bio stock or stock options. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Synergistic screening in preventive cardio-oncology. A Rational for combining breast cancer and CVD screening with mammography [3, 13, 28, 31]. B Purposed workflow for standardized breast arterial calcification (BAC) reporting and follow-up CVD risk assessment. Figure components are from Infografia
Fig. 1
Fig. 1
Synergistic screening in preventive cardio-oncology. A Rational for combining breast cancer and CVD screening with mammography [3, 13, 28, 31]. B Purposed workflow for standardized breast arterial calcification (BAC) reporting and follow-up CVD risk assessment. Figure components are from Infografia
Fig. 2
Fig. 2
CAC on CT in preventive cardio-oncology. Figure components are from Microsoft Powerpoint and Infografia and not of actual patients
Fig. 3
Fig. 3
CHIP in preventive cardio-oncology. A CHIP pathophysiology [51, 65]. B Example of CHIP workflow. Figure components are from Infografia
Fig. 3
Fig. 3
CHIP in preventive cardio-oncology. A CHIP pathophysiology [51, 65]. B Example of CHIP workflow. Figure components are from Infografia
Fig. 4
Fig. 4
Considerations in preventive cardio-oncology. A Cancer treatment cardiotoxicities. B Preventive cardio-oncology: continuum of care in cancer patients. Figure components are from Infografia
Fig. 4
Fig. 4
Considerations in preventive cardio-oncology. A Cancer treatment cardiotoxicities. B Preventive cardio-oncology: continuum of care in cancer patients. Figure components are from Infografia
Fig. 5
Fig. 5
Graphic abstract. Next generation risk markers in preventive cardio-oncology
See this image and copyright information in PMC

References

    1. Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, et al. Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association. Circulation. 2018;137(8):e30–66. - PMC - PubMed
    1. Bellinger AM, Arteaga CL, Force T, Humphreys BD, Demetri GD, Druker BJ, et al. Cardio-oncology: how new targeted cancer therapies and precision medicine can inform cardiovascular discovery. Circulation. 2015;132(23):2248–58. - PMC - PubMed
    1. Sturgeon KM, Deng L, Bluethmann SM, Zhou S, Trifiletti DM, Jiang C, et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J. 2019;40(48):3889–97. - PMC - PubMed
    1. Brown S-A. Preventive cardio-oncology: the time has come. Frontiers in Cardiovascular Medicine. 2020;6:187. - PMC - PubMed

    1. Handy CE, Quispe R, Pinto X, Blaha MJ, Blumenthal RS, Michos ED, et al. Synergistic opportunities in the interplay between cancer screening and cardiovascular disease risk assessment: together we are stronger. Circulation. 2018;138(7):727–34.

      Describes overlap in screening for CVD and malignancy.

Publication types

MeSH terms