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Next Generation Risk Markers in Preventive Cardio-oncology

  • Coronary Heart Disease (S. Virani and M. Al Rifai, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

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.

Summary

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.

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Funding

This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Numbers UL1TR001436 and KL2TR001438. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA

    Morgan Lamberg, Rachel Goodman & David Rayan

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Andrea Rossman, Alexandra Bennett, James MacLeod & Ragasnehith Maddula

  3. Department of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA

    Sabrina Painter

  4. Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA

    Krishna Doshi

  5. Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, USA

    Alexander Bick

  6. Preventive Cardiology, Rochester Regional Health, Rochester, MN, USA

    Simone Bailey

  7. Cardio-Oncology & Preventive Cardiology Programs, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Sherry-Ann Brown

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  1. Morgan Lamberg
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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.

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Lamberg, M., Rossman, A., Bennett, A. et al. Next Generation Risk Markers in Preventive Cardio-oncology. Curr Atheroscler Rep 24, 443–456 (2022). https://doi.org/10.1007/s11883-022-01021-x

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