Forewarned and forearmed

Have you looked in the rearview mirror lately? Complications may be closer than they once looked. Considering risks and alternatives now may improve outcomes later.    

Research that informs physicians of current trends and what’s down the pike holds immense value. This week, Willis Wu, MD, of the Heart and Vascular Institute at the Cleveland Clinic, and colleagues published results of a study that assessed mortality risk in cancer survivors who had past chest radiation who underwent major cardiac surgery. They found that patients who had had radiation therapy were at much higher risk of death compared with those who had not. The mortality rate was 55 percent vs. 28 percent, respectively.

Radiation therapy is an effective weapon against some cancers, but it is not without cardiovascular casualties that manifest over time. The American Cancer Society projects that in invasive breast cancer alone, physicians will diagnose more than 232,000 new cases this year. Some of those patients will be treated with radiation; some will develop radiation-associated cardiac diseases; and some will require cardiac surgery.  

Wu et al recommended that cardiothoracic surgeons proceed cautiously with this patient population and urged the community to investigate treatments such as percutaneous transaortic valve replacement.

Another study published this week examined the antiarrhythmic drug amiodarone, which has been under scrutiny for possibly heightening the risk of thyroid and other cancers. The analysis relied on insurance and registry data--not always ideal resources. But in Taiwan, these databases are, to use the authors’ words, “not only reliable but exhaustive.”

Vincent Yi-Fong Su, MD, of Taipei Veterans Hospital in Taiwan, and colleagues reported a borderline significant increase in cancer, with an increased risk for male patients and patients with more than 180 cumulative defined daily doses of amiodarone within the first year of therapy.

Knowing which patients might benefit or be harmed by an intervention is a huge asset. These studies, while not controlled, randomized clinical trials, nonetheless may help to make physicians aware of complications and identify strategies to avoid poor outcomes.

Candace Stuart

Cardiovascular Business, editor