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Cardiac biomarkers predict cancer mortality

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Findings could help integrate cardiology, oncology

This study opens the potential for new management strategies integrating cardiology and oncology. Treating overt and perhaps subclinical cardiac dysfunction may improve outcomes in patients with cancer, and may possibly improve progression-free cancer survival based on optimizing cancer treatment and preventing interruptions. These biomarkers could serve as a surveillance strategy for both cardiologists and oncologists. It would be equally tantalizing to know whether treating the cancer effectively improves cardiac outcomes, but this will be more challenging to unravel if the cancer treatment imparts potential cardiotoxicity.

The key next stage will be to reproduce these findings in a prospectively designed multicenter study with larger numbers to validate the conclusion, collect the mode of death, and also to consider whether serial biomarker assessment adds further predictive power. Pavo et al. should be congratulated on bringing to our attention the widening complexity of biomarker biology and the potential to identify single biomarkers with the unique properties to predict both cardiovascular and oncology outcomes.

Dr. Alexander Lyon is at Imperial College and Royal Brompton Hospital in London. He reported receiving research funding and having consulting and advisory relationships with Pfizer, Onyx Pharmaceuticals, Ferring Pharmaceuticals, and Clinigen Group. These remarks are from his editorial (Heart 2015 Sep. 28. doi:10.1136/heartjnl-2015-308208).




High circulating levels of six cardiovascular biomarkers predicted cancer mortality even before the start of treatment and regardless of tumor type or stage, according to a study published online Sept. 28 in Heart.

Cancer patients had high levels of these biomarkers even though they had no clinical signs of heart disease or concurrent infections, wrote Noemi Pavo of Medical University of Vienna. The findings suggest that these patients could benefit from enhanced heart failure therapies that go beyond the current focus on preventing cardiotoxic side effects of chemotherapy and radiotherapy, noted Dr. Pavo and her associates.

Cardiovascular hormone and peptide levels can rise during cancer treatment, but whether cancer itself affects these biomarkers has been unclear, the investigators said. Therefore, they prospectively measured levels of five cardiovascular hormones – NT-proBNP, MR-proANP, MR-proADM, CT-pro-ET, and copeptin – in addition to high-sensitive troponin, the proinflammatory markers interleukin 6 and C-reactive protein, and cytokines serum amyloid A, haptoglobin, and fibronectin, in 555 patients with newly diagnosed, as-yet-untreated cancer (Heart 2015 Sep 28. doi:10.1136/heartjnl-2015-307848).

A total of 186 patients (34%) died after an average of 25 months of follow-up, the researchers reported. Levels of all cardiovascular hormones and hsTnT increased with tumor stage progression. After the researchers controlled for age, tumor type, tumor stage, glomerular filtration rate, and cardiac status, rising levels of all five cardiac hormones and hsTnT independently predicted mortality, with adjusted hazard ratios ranging from 1.21 for CT-proET-1 and hsTnT to 1.54 for the natural logarithm of NT-proBNP, and P values ranging from .014 to less than.001.

“All of these markers are strongly related to mortality, implying a direct association with disease progression,” the researchers said. “While our endpoint [was] all-cause mortality, precise information about the percentage of cardiovascular-related death would certainly be of important clinical interest. Since post hoc interpretations of certifications of death are not reliable, the development of a cardiac disease during cancer progression should be documented in longitudinal studies in the future.”

An unrestricted grant from Thermo Fisher funded the study. The researchers declared no competing interests.

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