Prepping for Treatment

Patients who are about to begin a cancer treatment that carries a risk of cardiac side effects should confirm that their cardiovascular status is as good as it can be, according to Daniel Lenihan, director of the clinical research program at Vanderbilt University Medical Center’s division of cardiovascular medicine in Nashville, Tenn.

"Think about someone who is having major surgery," Lenihan says. "We do pre-op evaluation; we test the heart function and blood pressure and cholesterol. We see if they have any condition that they didn’t know about and address it. For a patient about to get an anthracycline or Herceptin, you want good preparation."

In a study of younger women with newly diagnosed breast cancer who were treated with anthracycline-based therapy, researchers found that uninterrupted statin therapy before and during chemotherapy reduced the risk of heart failure. However, the study was small and not definitive enough to recommend preventive statin therapy.

For individual clinicians caring for patients with or at risk of developing chemotherapy- or radiation-induced cardiomyopathy, the challenge is to treat the life-threatening malignancy while simultaneously managing cardiac risk, as well as detecting and treating cardiotoxicity, should it arise, Lenihan says.

Among the newer options to achieve that goal is using cardiac biomarkers, particularly troponin I and B-type natriuretic peptide (BNP) prior to treatment for cancer, to identify those patients who are at risk of cardiac dysfunction.

Studies indicate that a rise in troponin I, a marker in cell death, may precede measurable changes in the left ventricular ejection fraction. BNP, associated with myocardial stretch, is a marker for volume overload. "BNP can increase when filling pressures rise even with normal left ventricular function," Lenihan says.

While these are promising indicators, Lenihan says, more study is needed on both statins and biomarkers.