Cardiovascular health is the essential but overlooked aspect in the management of cancer survivors

This editorial refers to ‘Association of Life’s Simple 7 with incident cardiovascular disease in 53 974 patients with cancer’, by H. Kaneko et al., https://doi.org/10.1093/eurjpc/zwac195. In recent years, cardio-oncology has become of greater interest to both academics and clinicians. This is due to increasing cancer survival rates, meaning many cancer survivors have chance to suffer from cardiovascular diseases (CVDs).1,2 Cardio-oncology addresses various aspects, such as chemotherapy-induced cardiac dysfunction, cancer therapy–related development/aggravation of vascular disease, venous thromboembolism, arrhythmia, and cancer survivorship care (Figure 1).3,4 Recently, clinicians have become increasingly aware of chemotherapy-induced cardiotoxicity. As such, regular patient monitoring using various imaging techniques and biomarkers is being performed.1,5 However, cancer survivorship care remains an unfamiliar concept to most clinicians, meaning fewer efforts are being made to address this issue.4,6 Various aspects of cardio-oncology and importance of survivorship care. CV, cardiovascular; CVD, cardiovascular disease. From this perspective, in this current edition of the European Journal of Preventive Cardiology, the study by Kaneko et al.7 has significant implications in the field of cardio-oncology. The authors evaluated the association between unfavourable cardiovascular (CV) health metrics and CVD events in cancer patients using a retrospective cohort database. For this analysis, seven CV health metrics, which are modified from Life’s Simple 7 CV health metrics from the American College of Cardiology/American Heart Association, were used. The included parameters were body mass index, smoking status, physical activity, eating habits, blood pressure, glucose, and total cholesterol levels. Three types of representative cancer, namely breast, colorectal, or stomach cancer, which are common in the Japanese population, were included in the study. In total, this cohort study involved >50 000 cancer patients. The authors showed that incidence of CVD increased with the number of unfavourable CV health metrics. Interestingly, this relationship was also evident in patients undergoing active cancer treatment. Such results demonstrate that cancer patients are no exception in maintaining healthy lifestyles and managing CV risk factors to minimize risk of CVD. However, these obvious findings are often overlooked in real clinical practice owing to the cancer therapy itself and concerns centring around future cancer recurrence. This study reminds us of and emphasizes the importance of holistic care, encompassing CV health management as well as cancer treatment, in cancer patients. Notably, unfavourable cholesterol, blood pressure, and physical activity levels were frequently observed among those with two non-ideal health metrics (63.2, 51.3, and 49.1%, respectively), representing a recurrent theme in CV health problems, highlighting a potential priority health goal for cancer patients. Moreover, recently, reverse cardio-oncology, in which cancer develops in CV patients has gained clinical attention.8 Taken together, these movements suggest cancer and CVD, which were previously recognized as separate clinical entities, are diseases that intricately affect each other with shared risk factors and pathways.3,4,8–10 However, it is also important to note the limitations of this study. Firstly, the relative importance of each risk factor was not reflected. It is unclear if the relative importance of risk factors such as physical activity is equal to that of blood glucose, in terms of increasing CVD risk. As such, additional stratifying analyses for CV risk which reflect the relative importance of each risk factor in cancer patients may be helpful. Secondly, as the authors state, the study results cannot be extrapolated to other types of cancer, such as haematologic malignancy of indolent course, hepatic cellular carcinoma, prostate cancer, or childhood cancer. In summary, more comprehensive efforts are warranted to achieve better health in cancer survivors. Such efforts should include routine screening and management for CVD risk. While implementation could be challenging, the importance of cardio-oncology and survivorship care in cancer survivors is likely to continue to grow with an increasing number of cancer survivors. Consequently, a multidisciplinary approach and active engagement are necessary to achieve better health in cancer patients. This work was supported by the Research Foundation of Internal Medicine, The Catholic University of Korea. The funders had no role in the study design, analysis, interpretation, or submission of this article. No new data were generated supporting the current article.