Santino Butler MD , Hyunsoo No MD , Felicia Guo BA , Gibran Merchant BS , Natalie J. Park BA , Scott Jackson MS , Daniel Eugene Clark MD , Lucas Vitzthum MD , Alex Chin MD, MBA , Kathleen Horst MD , Richard T. Hoppe MD , Billy W. Loo MD, PhD , Maximilian Diehn MD, PhD , Michael Sargent Binkley MD, MS
{"title":"Predictors of Atrial Fibrillation After Thoracic Radiotherapy","authors":"Santino Butler MD , Hyunsoo No MD , Felicia Guo BA , Gibran Merchant BS , Natalie J. Park BA , Scott Jackson MS , Daniel Eugene Clark MD , Lucas Vitzthum MD , Alex Chin MD, MBA , Kathleen Horst MD , Richard T. Hoppe MD , Billy W. Loo MD, PhD , Maximilian Diehn MD, PhD , Michael Sargent Binkley MD, MS","doi":"10.1016/j.jaccao.2024.08.007","DOIUrl":"10.1016/j.jaccao.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) has been associated with thoracic radiotherapy, but the specific risk with irradiating different cardiac substructures remains unknown.</div></div><div><h3>Objectives</h3><div>This study sought to examine the relationship between irradiation of cardiac substructures and the risk of clinically significant (grade ≥3) AF.</div></div><div><h3>Methods</h3><div>We analyzed data from patients who underwent definitive radiotherapy for localized cancers (non–small cell lung, breast, Hodgkin lymphoma, or esophageal) at our institution between 2004 and 2022. The 2-Gy fraction equivalent dose was calculated for cardiac substructures, including the pulmonary veins (PVs), left atrium, sinoatrial node, and left coronary arteries (the left main, left anterior descending, and left circumflex arteries). Competing risk models (subdistribution HRs [sHRs]) for AF incidence were adjusted for the Mayo AF risk score (MAFRS).</div></div><div><h3>Results</h3><div>Among 539 patients, the median follow-up was 58.8 months. The 5-year cumulative incidence of AF was 11.1% for non–small cell lung cancer, 8.3% for esophageal cancer, 1.3% for breast cancer, and 0.8% for Hodgkin lymphoma. Increased AF risk was associated with a higher PV maximum dose (d<sub>max</sub>) (sHR: 1.22; <em>P <</em> 0.001), larger left atrial volume (sHR: 1.01; <em>P =</em> 0.002), greater smoking history in pack-years (sHR: 1.01; <em>P =</em> 0.010), and higher MAFRS (sHR: 1.16; <em>P <</em> 0.001). PV d<sub>max</sub> remained a significant predictor of AF across different MAFRS subgroups (<em>P</em><sub>interaction</sub> = 0.11), and a PV d<sub>max</sub> >39.7 Gy was linked to a higher AF risk, even when stratified by MAFRS.</div></div><div><h3>Conclusions</h3><div>PV d<sub>max</sub> is a significant predictor of grade ≥3 AF regardless of underlying risk factors. These findings highlight the importance of cardiac substructures in radiation toxicity and suggest that various PV dose metrics should be further validated in clinical settings.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 6","pages":"Pages 935-945"},"PeriodicalIF":12.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Rise and Fall of C-Reactive Protein","authors":"Tzu-Fei Wang MD, MPH","doi":"10.1016/j.jaccao.2024.10.001","DOIUrl":"10.1016/j.jaccao.2024.10.001","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 6","pages":"Pages 976-978"},"PeriodicalIF":12.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacqueline B. Vo PhD, RN, MPH , Véronique L. Roger MD, MPH
{"title":"Cardiovascular Disease and Breast Cancer","authors":"Jacqueline B. Vo PhD, RN, MPH , Véronique L. Roger MD, MPH","doi":"10.1016/j.jaccao.2024.10.008","DOIUrl":"10.1016/j.jaccao.2024.10.008","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 6","pages":"Pages 904-906"},"PeriodicalIF":12.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darryl P. Leong MBBS, MPH, MBiostat, PhD , Avirup Guha MBBS, MPH , Alicia K. Morgans MD, MPH , Tamim Niazi MDCM , Jehonathan H. Pinthus MD, PhD
{"title":"Cardiovascular Risk in Prostate Cancer","authors":"Darryl P. Leong MBBS, MPH, MBiostat, PhD , Avirup Guha MBBS, MPH , Alicia K. Morgans MD, MPH , Tamim Niazi MDCM , Jehonathan H. Pinthus MD, PhD","doi":"10.1016/j.jaccao.2024.09.012","DOIUrl":"10.1016/j.jaccao.2024.09.012","url":null,"abstract":"<div><div>Cardiovascular disease is common in patients with prostate cancer and is a significant cause of death. Cardiovascular risk factors are frequent in this population and are often not addressed to thresholds recommended by cardiovascular practice guidelines. Androgen deprivation therapy reduces muscle strength and increases adiposity, increasing the risk for diabetes and hypertension, although its relationship with adverse cardiovascular events requires confirmation. Androgen receptor pathway inhibitors, including androgen receptor antagonists and cytochrome P450 17A1 inhibitors confer incremental risks for hypertension and cardiovascular events to androgen deprivation therapy. Lower cardiovascular risk with gonadotropin-releasing hormone antagonists compared with agonists requires confirmation in well-designed randomized trials.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 6","pages":"Pages 835-846"},"PeriodicalIF":12.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wonyoung Jung MD, PhD, MSc , In Young Cho MD, MPH , Jinhyung Jung PhD , Mi Hee Cho MD , Hye Yeon Koo MD , Yong-Moon Mark Park MD, PhD , Kyungdo Han PhD , Dong Wook Shin MD, DrPH, MBA
{"title":"Changes in Physical Activity and Cardiovascular Disease Risk in Cancer Survivors","authors":"Wonyoung Jung MD, PhD, MSc , In Young Cho MD, MPH , Jinhyung Jung PhD , Mi Hee Cho MD , Hye Yeon Koo MD , Yong-Moon Mark Park MD, PhD , Kyungdo Han PhD , Dong Wook Shin MD, DrPH, MBA","doi":"10.1016/j.jaccao.2024.09.013","DOIUrl":"10.1016/j.jaccao.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Cancer survivors face an elevated risk of cardiovascular disease, with physical inactivity after cancer treatment potentially worsening this risk.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the association between physical activity before and after a cancer diagnosis and the risk for heart disease.</div></div><div><h3>Methods</h3><div>A nationwide cohort of 269,943 cancer survivors (mean age 56.3, 45.7% men) was evaluated for physical activity adherence 2 years before and after diagnosis. The primary outcomes were the incidence of myocardial infarction (MI), heart failure (HF), and atrial fibrillation. Subdistribution HRs (sHRs) and 95% CIs were calculated using Gray’s method, accounting for death as a competing risk.</div></div><div><h3>Results</h3><div>Over a follow-up period of 1,111,329.28 person-years, compared with those who remained inactive, persistent physical activity was associated with a 20% reduction in MI risk (sHR: 0.80; 95% CI: 0.70-0.91) and a 16% reduction risk in HF risk (sHR: 0.84; 95% CI: 0.78-0.90). Initiating physical activity after a cancer diagnosis was linked to an 11% lower risk for MI (sHR: 0.89; 95% CI: 0.79-0.99) and a 13% lower risk for HF (sHR: 0.87; 95% CI: 0.82-0.93). Being active only before diagnosis was associated with a 20% lower risk for MI (sHR: 0.80; 95% CI: 0.71-0.91) and a 6% lower risk for HF (sHR: 0.94; 95% CI: 0.88-1.00). No association was observed between physical activity and atrial fibrillation risk. Associations varied by primary cancer site.</div></div><div><h3>Conclusions</h3><div>These findings underscore the importance of maintaining physical activity for cardiovascular health in cancer survivors and suggest that physical activity before a diagnosis may offer enduring protection against ischemic heart disease and cardiac dysfunction.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 6","pages":"Pages 879-889"},"PeriodicalIF":12.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cancer Survivors and Cardiovascular Risk: What Patients Should Know From the Perspective of Another Survivor","authors":"Steven Petrow","doi":"10.1016/j.jaccao.2024.08.002","DOIUrl":"10.1016/j.jaccao.2024.08.002","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 808-810"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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