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Heart Failure and Breast Cancer: Emerging Controversies Regarding Some Cardioprotective Strategies

2014; Elsevier BV; Volume: 20; Issue: 6 Linguagem: Inglês

10.1016/j.cardfail.2014.04.014

1532-8414

Salvatore Patanè,

Cancer-related cognitive impairment studies

I have read with great interest the excellent article by Akanksha Thakur and Ronald M. Witteles, "Cancer therapy–induced left ventricular dysfunction: interventions and prognosis."1 Cardiotoxicity prevention remains an important challenge,2 as well as its surveillance and management in cancer survivors.3–8 Although with appropriate cardiac intervention the majority of patients can achieve left ventricular ejection fraction (LVEF) recovery and complete their cancer therapy,1 cardiologists and oncologists should also be aware of emerging controversies regarding some cardioprotective strategies in breast cancer patients.9–12 Continuous use of beta-blockers (BBs) is associated with lower risk of breast cancer development in diabetic patients9,10 and with lower incidence of heart failure,11 but the Commonly Used Medications and Breast Cancer Outcomes (COMBO) cohort has indicated that angiotensin-converting enzyme inhibitor (ACE-I) and BB use warrants further evaluation regarding second primary breast cancer,12 and greater attention has been focused on breast cancer outcomes.13 Recently, although most individual BBs have shown no association with recurrence of breast cancer, metoprolol and sotalol have been associated with increased recurrence rates of breast cancer,13 and a little evidence of association between post-diagnostic BB use and breast cancer progression has also been reported.14 Although no evidence has been reported of increased risks of cancer-specific mortality in breast cancer patients using ACE-Is15 or of recurrence of breast cancer with angiotensin receptor blockers (ARBs),13 ACE-Is were associated with a slightly increased breast cancer recurrence hazard13 and with weakly increased death rates.16 Furthermore, combined use of ACE-Is/ARBs and BBs during the first 3 months of adjuvant trastuzumab therapy was associated with the degree of hypertension and decrease in left ventricular ejection fraction (LVEF), whereas the same combined use is associated with a recovery of LVEF during months 3–12 of adjuvant trastuzumab therapy.17 Additional research is needed for patient safety, and the partnership of both basic and clinical research may help to promote new strategies18 also in order to find ideal nontoxic anti cancer drugs.