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Mar 28, 2019

Imaging Scans for Cancer Provide Useful Information About Heart Health

Life-saving information about cardiovascular risk is overlooked about half of the time.

Cancer doctors are passing up valuable information about risk for heart disease, based on a recent study that analyzed results of CT scans performed before cancer treatment. The study found CT scans help identify patients at high risk for heart disease but that this information is only acted upon in half of cases, highlighting a huge missed opportunity for treatment.

Presented at the American College of Cardiology’s 68th Annual Scientific Session, this study took a closer look at how information from cancer-related CT scans are used in clinical practice.

Computed tomography (CT) scans use X-ray imaging to provide a picture of what’s happening inside the body. When it comes to cancer treatment, CT scans are used to assess a tumor’s size and spread before starting patients on therapy. However, these scans also provide a clear view of plaque buildup in the heart’s arteries and are used to identify patients at risk for heart disease—the leading killer of Americans.

The problem is that radiologists only reported information about plaque buildup about half the time, based on study results. If this reporting was done routinely, it could potentially help doctors identify and treat patients who have plaque buildup (an indicator of heart disease) and are at high risk for other heart problems, researchers said.

“This is essentially free information because the patients are undergoing the CT scans anyway, and we’d like to see it reported more frequently,” said Matthew Hooks, MD, a resident physician at the University of Minnesota and the study’s lead author. “It would be particularly helpful to know if a patient has evidence of early coronary artery disease before starting cancer treatment that can potentially harm the heart.”

The recent study included 1,001 patients undergoing treatment for cancer. All participants underwent a CT scan before starting an anthracycline drug or trastuzumab—two cancer treatments known to increase the risk of heart problems.

The research team looked at the results of each CT scan to assess coronary artery calcium and see whether it was noted on the original report. Coronary artery calcium, often referred to as CAC, refers to the buildup of plaque in the arteries and is linked to increased risk for heart disease and life-threatening heart events.

Overall, researchers found that one-third of participants had evidence of dangerous buildup of plaque in their arteries. However, these results were only noted in the CT report about half the time and only seven patients started aspirin or cholesterol-lowering statins after their scan. This likely suggests at least some doctors missed the opportunity to use the CT scan to identify patients with high cardiovascular risk and take steps to intervene, Hooks said.

“As cancer treatments have improved and more patients are surviving cancer, we have become more aware of how these therapies might affect patients’ heart health in the long term,” Hooks said. “We hope to find out whether we can use CAC as a predictive tool to identify patients who may have poor cardiac outcomes and potentially guide the type of chemotherapy they get or guide whether preventative measures should be implemented prior to starting chemotherapy.”

A separate study, which was presented at the same national conference, found that mammograms—a routine screening for breast cancer—also provide useful information about heart health.

The study, which analyzed mammograms and coronary angiograms in 1,150 women, found that women with calcification in the breast arteries were 53 percent more likely to have heart disease than women without breast artery calcification.

Since mammograms are performed far more frequently than coronary angiograms, the findings suggest information from mammogram reports could help doctors identify women at risk of having heart disease and intervene early, said Rajendra Patel, MD, lead author of the study conducted at Navicent Health/Mercer University School of Medicine.

The next step, according to experts, is to see how well information from these cancer screenings predicts which patients develop heart disease and other complications. “Once we know that, it can help make a strong case for whether those patients should be treated aggressively with aspirin and statins, for example, which is not happening right now,” Hooks said.

Questions for You to Consider

  • What is coronary artery calcification?
  • Coronary artery calcification (CAC) is the buildup of calcium in the arteries, which can cause blood vessels to narrow and lead to the development of heart disease.
  • How can I reduce my risk for heart disease?
  • Healthy lifestyle choices are key to reducing risk for heart disease. By eating a heart-healthy diet and staying physically active, you can help significantly reduce heart disease risk. Knowing your numbers—body mass index, blood pressure, cholesterol, and blood sugar—and family history is also important so that you can address any risk factors you may have for heart disease.

Infographic: Coronary Artery Disease (CAD)


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