الفهرس 
AGE-RELATED CARDIOVASCULAR CHANGESOnly 14 pages are availabe for public view
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Abstract
A
s cancer therapies have become more advanced, significant improvements in the survival rates of a number of cancers have resulted in a continued rise in long-term cancer survivors with serious complications as CVD.
The cardiotoxicity of anticancer agents can lead to significant complications that can affect patient treatment plan for various malignancies. The severity of such toxicity depends on many risk factors such as aging, smoking, obesity, inactivity. Moreover, toxicity can be affected by current or previous treatment with other antineoplastic agents and medical comorbidities.
Cardiotoxicity of anticancer agents varies from asymptomatic LV dysfunction to heart failure with diastolic dysfunction or low EF and myocardial ischemia, angina, arrhythmia and even sudden death.
Cardio-oncology role is to focus toward disease prevention and treatment, to balance the essential treatment for cancer patients and their cardiovascular risk.
The scope of cardio-oncology is wide and includes not only prevention, detection, monitoring and treatment of cardiovascular toxicity related to anticancer therapy, but also the development of future anticancer treatments that have minimal effect on cardiovascular health.
This study was conducted to assess the cardiovascular function in elderly patients diagnosed with malignancy.
The study included one hundred (100) elderly participants, both men and women, sixty years and above.
All participants included in the study were subjected to comprehensive geriatric assessment (CGA), laboratory investigations (lipid profile, fasting blood glucose, C-reactive protein), Echocardiography (ECHO) and Electrocardiogram (ECG).
Cardiotoxicity occurred in 57% of study participants, following their treatment, in different patterns as follow: low EF (59.65%), symptomatic diastolic dysfunction (57.89%), myocardial ischemia (45.61%), QTc interval prolongation (21.05%) or arrhythmia (14.04%).
Older age, smoking , longer cancer duration, hypertension, diabetes and dyslipidemia were risk important factors for cardiotoxicity in different patterns (heart failure with low EF, symptomatic diastolic dysfunction and myocardial ischemia).
There was a statistically significant negative correlation between EF and each of: age, smoking index, cancer duration, chemotherapy duration, levels of triglycerides, total cholesterol, LDL, fasting blood glucose and CRP. Conversely, EF was positively correlated with body mass index and HDL.
Study participants who had received certain anticancer agents (Anthracycline, 5-Fluorouracil, Capecitabine, Arsenic trioxide, and Lapatinib), certain targeted therapy agents (Pertuzumab and Trastuzumab); and those who received radiotherapy (most commonly radiotherapy to the chest) experienced more cardiotoxicity.
Comprehensive geriatric assessment revealed that participants with cardiotoxicity had higher prevalence of depression, malnutrition and functional impairment.
CONCLUSION
1. Cardiotoxicity is common in elderly cancer patients; and has different patterns (heart failure with low EF, symptomatic diastolic dysfunction, myocardial ischemia, or QTc interval prolongation).
2. Older age, smoking, longer cancer duration, hypertension and dyslipidemia are important risk factors for cardiotoxicity.
3. Cancer therapies (certain chemotherapy agents, targeted therapy agents and radiotherapy to the chest) increase the risk of cardiotoxicity.
4. Elderly participants with cardiotoxicity had higher prevalence of depression, malnutrition and functional impairment.
RECOMMENDATIONS
1. Comprehensive geriatric assessment, including screening of cardiovascular risk factors, is as essential step in the evaluation and monitoring of elderly cancer patients, especially those receiving cancer therapy.
2. Prevention and control of modifiable cardiovascular risk factors help to prevent/ameliorate treatment related cardiotoxicity.
3. Pharmacological and non-pharmacological interventions should be implemented as preventive or therapeutic measures for cancer therapy-related cardiotoxicity.
4. Collaboration between geriatricians, cardiologists, and oncologists in a “Cardio-Oncology Team” approach, help to focus on cardiovascular function and improve outcome and quality of care in elderly patients with malignancy.