![]() ![]() Radiation‐associated cardiotoxicity appears to be delayed-typically 10 to 30 years following treatment. 8 Preexisting cardiovascular disease, 6 younger age at the time of radiation and presence of other cardiac risk factors such as hypertension, dyslipidemia, diabetes, family history of coronary artery disease (CAD), active smoking, and inactivity also increase the risk of radiation‐induced cardiovascular disease. 6 Concomitant use of cardiotoxic chemotherapy agents, typically anthracyclines, trastuzumab, and fluorouracil further increase the risk of heart disease. 7 Complications are more commonly seen in patients with left‐sided rather than right‐sided breast cancer as a larger portion of the heart is included in the radiation field. Other risk factors for development of cardiovascular disease after radiation include the dose of radiation per fraction, the volume of heart irradiated, and the extent to which the coronary arteries are included in the radiation field. 5 A relative increase of 7.4% in risk of coronary events for each Gy of radiation to the heart has been demonstrated in women with previous breast cancer having received radiation. 4 Trials show that dose‐escalation of radiation therapy for lung cancer is associated with an increased risk of subsequent cardiac events (acute coronary syndromes, arrhythmias, pericardial disease). Although complications can be seen with any dose, there is a linear increase in risk of valvular heart disease with total dose of radiation above 30 Gy/m 2. The total dose of mediastinal radiation received is a major risk factor for subsequent development of cardiovascular disease. ![]() In this article, we review the most important clinical effects of radiation therapy on the cardiovascular system, with a focus on recent data regarding its treatment.Ī number of risk factors have been linked to radiation‐induced cardiovascular disease. 3 These patients present a therapeutic challenge as there is a paucity of data regarding the specific considerations in their management. ![]() An increase of 7.2‐fold in cardiovascular death has been demonstrated in patients having received former radiation techniques before the 1970s. 2 Nowadays, among survivors of cancer, an increase of 1.7‐ to 2‐fold in cardiovascular death is seen in patients who have undergone radiotherapy. The first data obtained regarding the effects of radiation on the cardiovascular system stem from the survivors of the Hiroshima and Nagasaki atomic bombings, which showed that nearly 10% of the observed group died of heart disease. 1 An increasing number of cancer survivors are seen with premature heart disease despite having no significant cardiovascular risk factors, often decades after completion of radiation treatments. At sufficient doses, radiation of the mediastinum can damage virtually any component of the heart-the myocardium, pericardium, valves, coronaries, and conduction system. Radiation therapy is still widely used in the treatment of numerous cancers despite a nonnegligible risk of complications-the consensus being that the benefits of radiation outweigh its risks in selected cases. Radiation‐induced cardiovascular disease, although well described in the literature, is an underrecognized phenomenon clinically. Nonstandard Abbreviations and Acronyms SAVR When appropriate, these patients should be referred for percutaneous management of valvulopathy and coronary disease. However, there is a trend toward fewer complications and lower mortality with catheter‐based rather than surgical approaches, likely because radiation makes these patients poor surgical candidates. Patients with radiation‐induced cardiovascular disease tend to do worse than their traditional counterparts for the same interventions. Physicians should treat other cardiovascular risk factors aggressively in this population and guidelines suggest obtaining regular imaging once symptomatology is established. Radiation causes fibrosis of all components of the heart and significantly increases the risk of coronary artery disease, cardiomyopathy, valvulopathy, arrhythmias, and pericardial disease. This pathology is often underrecognized by clinicians and there is little known on how to manage this population. However, cancer survivors can develop a wide array of cardiotoxic complications related to radiation. Radiation therapy demonstrates a clear survival benefit in the treatment of several malignancies. Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
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