The Rogers Foundation announces a second landmark gift, building on its $130 million gift in 2014, to sustain the Ted Rogers Centre for Heart Research in perpetuity and bring the promise of precision cardiac health to patients across Canada and globally. In 2014, the...
In the years after chemotherapy, women who survive breast cancer face uncertain effects on their cardiovascular health. The intensity of some cancer treatments raises the risk for problems that range from coronary disease to arrhythmia to stroke to heart failure.
The key question is: what exactly is the risk of heart
damage from these treatments? And what should their doctors do to help them?
Dr. Husam Abdel-Qadir, a cardiologist-scientist at Women’s
College Hospital and Peter Munk Cardiac Centre, led a study published in the
prestigious European Heart Journal that has provided the
means to an answer.
Analyzing 10 years of population data on 90,000 Ontario
women with early breast cancer, Dr. Abdel-Qadir built a model that can predict
each woman’s risk of suffering a major cardiovascular event within a decade.
“To actually quantify the risk for these women is new, and it expands the conversation to the overall questions of heart health,” said Dr. Abdel-Qadir, whose work in this area is part of the Ted Rogers Centre’s Cardiotoxicity Prevention Program. “Before even beginning cancer treatment, this tool can help inform treatment decisions that tailored to each individual patient.”
Gazing five and 10
years into the future
The risk prediction model was developed and validated by seeing how those 90,000 women interacted with the health-care system over a nine-year period. The research team could assess health status, who developed a serious heart problem, how long it took to develop, and what risk factors were involved.
They sought to design a tool that front-line care providers and even patients could use. So they took the data from their statistical model and distilled it into a risk score that could be easily interpreted.
It is essentially a calculator, assigning points based on such
individual factors as age, blood pressure levels, existing heart issues, and
comorbidities like diabetes and kidney disease. How many points any one woman
generates can map their risk of suffering a serious adverse cardiovascular
event – even death – at five and 10 years in the future.
The model is now proven capable of giving predictions for
any random woman with early breast cancer. Most urgently, the study found that
women who scored in the highest zone were over 40 times more likely to
experience a major heart event than women in the lowest zone. Thankfully, most
women have low scores, which should provide reassurance as they go on with the
chemotherapy necessary to treat their breast cancer.
Empowering patients
to manage their cardiovascular risk
“We hope this tool can be used quite widely to manage
cardiovascular risk among women with breast cancer no matter where they live,
rather than a model that requires trained specialists to perform,” says Dr.
Abel-Qadir.
Anyone diagnosed with cancer must of course focus on its
treatment right away. Through this model, women at low risk of future heart
problems can feel empowered to get the necessary cancer therapy without concern
over its cardiovascular impact. At the same time, the model will help identify
the very few women whose risk of heart disease may be so high that cancer
treatment should be modified.
The model’s lasting benefit is that it can be used to set up
each patient for support in the right areas in the years to come. It can
suggest to doctors when and how each woman should be followed up with, who
requires the care of a cardiologist (even before chemotherapy), and precisely
where near- and long-term treatment decisions should focus.
“The cardio-toxic impact of system therapies is a very
important area, and it is deservedly gaining attention,” says Dr. Abel-Qadir.
“I see rising interest among oncologists, who care about their patient’s entire
health because they want to provide the best care possible. And breast cancer
patients themselves are increasingly asking to be referred to our Centre to be
evaluated.”
With this risk calculator, those patients can make personal
decisions about their cancer therapy, and take steps to manage their own
cardiovascular risk.