Aortic wall stiffness as a side-effect of anti-cancer medication

ABSTRACT

Introduction: Malignancies and cardiovascular disease are the two leading causes of mortality worldwide. There is a growing concern that anti-cancer drugs may lead to increased cardiovascular morbidity among cancer survivors. This may be the result of direct effects of the cancer treatment on heart function, or due to an indirect acceleration of atherosclerosis.

Areas covered: We searched two bibliographic databases [PubMed, Scopus] and one full-text database (Google Scholar) for publications on chemotherapy and arterial stiffness since 1970. Anthracyclines, alkylating agents and tyrosine kinase inhibitors seem to affect arterial elastic properties. These effects can be non-reversible and may appear after treatment termination. Monoclonal antibodies may induce either a temporary increase or no change on arterial stiffness of patients with malignancies. Anti-microtubule agents and antimetabolites have not been extensively studied so far.

Expert opinion: This literature review suggests that certain anticancer medications may impair arterial stiffness, and that assessment of arterial elastic properties before and after initiation of anti-neoplasmatic therapy may be clinically useful in order to develop protective strategies against chemotherapy-induced vascular effects. Further research is warranted to confirm the effects of anti-cancer agents on arterial stiffness, as well as their potential clinical implications. Future research lies in finding new targeted biomarkers identifying arterial stiffness such as micro RNAs while imaging techniques could also be implemented in assessment of vascular toxicity.

KEYWORDS:

• Arterial stiffness
• anti-cancer agents
• anthracyclines
• monoclonal antibodies
• alkylating agents
• tyrosine kinase inhibitors
• anti-microtubule agents
• antimetabolites
• malignancies
• cardiovascular disease
• cardiotoxicity

Article highlights

• Anthracyclines, alkylating agents and tyrosine kinase inhibitors exert adverse effects on arterial elastic properties and these effects can be non-reversible and may appear after the termination of treatment

• Assessment of vascular stiffness could be implemented in cardiovascular assessment prior to initiating anti-neoplasmatic agents with cardiovascular toxicity, in order to design cardiovascular protective strategies

• Treatment with angiotensin enzyme inhibitors seems to prevent cardiotoxicity in cancer patients and reduces arterial stiffness in general population

• Limitations in using arterial stiffness indices in everyday practice can be overcome by new emerging technologies using oscillometry and ultrasound for the assessment of arterial stiffness

• The identification of an aberrant production of micro-RNAs can help identify epigenetic changes that cause vascular toxicity and arterial stiffness

• Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography can be used for the assessment of arterial inflammation that has in turn been associated with increased arterial stiffness

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.