Thread by @drbrowncares

1/ Hot-off-the-press!

Tweetorial on Role of Angiotensin‐Converting Enzyme Inhibitors & β‐Blockers in Primary Prevention of Cardiac Dysfunction in Breast Cancer Pts

ahajournals.org/doi/10.1161/JA…

#CardioOnc #CardioOncology #PrevCardioOnc

@avolgman @AnaBaracCardio @DrTochiCardiOnc

2/ Approx 4 million American 👩🏽👩‍🦳 are currently living with a hx of invasive breast ca, w/ 270,000 diagnosed within the past year. Among these 👩🏽👩‍🦳, 64% are aged ≥65 years. Among older 👩🏽👩‍🦳 survivors of breast cancer, cardiovascular disease (#CVD) is the leading cause of death

3/ Are ACEIs and β‐blockers indicated and efficacious for everyone with breast cancer? Should we offer these medications prophylactically to all patients planned for chemotherapy, radiation, or targeted therapy? #CardioOnc #CardioOncology

4/ Alternatively, should we restrict these medications to patients deemed to be high risk for developing cardiovascular toxicity? How is risk defined? Will precision medicine be useful for making this determination? #CardioOnc #CardioOncology

5/ A meta‐analysis published in 2019 investigated the efficacy of neurohormonal drugs in preventing cardiovascular toxicity in patients receiving chemotherapy.6 Neurohormonal drugs included ACEIs, angiotensin receptor blockers, & mineralocorticoid receptor antagonists. #CardioOnc

6/ The comparison groups received placebo. Seventeen randomized controlled trials were included in the meta‐analysis. North America included 1984 individuals. Follow‐up across all 17 trials ranged from 24 weeks to 2 years. #CardioOnc #CardioOncology

7/ All studies included some participants w/ diabetes mellitus, hypertension, or both. Patients were treated w/ anthracyclines, HER2 antagonists, or a combo. 12 studies assessed β‐blockade; 10 assessed ACEIs, ARB, or mineralocorticoid receptor antagonism; 5 studies assessed both.

8/ The median baseline LVEF was 59% to 71% across the studies. Pooling the 17 trials, the overall absolute attenuation of LVEF decline between patients who received prophylactic neurohormonal therapies & those who did not was 3.96% (95% CI, 2.90–5.02%). #CardioOnc #CardioOncology

9/ Various groups have attempted to define risk for cardiovascular toxicity, with a number of publications reporting clinical risk scores. #PrevCardioOnc #CardioOnc #CardioOncogy @PrevCardioOnc

10/ Although a multivariable risk score has been designed to include genomic data to improve risk prediction for development of cardiomyopathy in childhood cancer, no precision risk score is available yet for breast cancer.

11/ A number of biotechnology tools are being studied for risk prediction of cardiovascular toxicities. Genomics, transcriptomics, proteomics, & math & computational modeling have been investigated for precision prediction of patients treated with anthracyclines with breast ca

12/ Identifying & managing risk in 👩🏽👩‍🦳 w/ breast ca undergoing tx w/anthracyclines w/ or w/out trastuzumab is critical for #cvPrev. ACEIs & β‐blockers may be efficacious in some women. Multivariable #PrecisionMed risk scores may become available in the future. #CardioOnc