Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

Boudoulas, Konstantinos Dean; Triposkiadis, Filippos; Gumina, Richard J.; Iliescu, Cezar; Boudoulas, Harisios

doi:10.1159/000521680

Cited by 14 publications

(9 citation statements)

References 51 publications

(125 reference statements)

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“…The results of the CORE trial support the concept that behavioral changes promoted by a multidisciplinary specialized team trained to deal with multiple comorbidities along with close medical management, as already recommended along the cardiovascular continuum, should be extended to cancer survivors at high cardiovascular risk . In a background in which the myriad complex links between CVD and cancer have been increasingly recognized, the results of the CORE trial reinforce the need for comprehensive tailored interventions to be included in supportive care across the span of cancer survivorship . These multidimensional interventions (eg, exercise, health education, dietary modification, and psychological counseling) could be provided on a background of existing resources in CR units, addressing cancer survivors’ specific needs, possibly followed by referrals to community programs aimed at maintaining supportive care …”

Section: Discussionmentioning

confidence: 99%

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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ImportanceCardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance.ObjectiveTo assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk.Design, Setting, and ParticipantsThis prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention.InterventionsParticipants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week.Main Outcomes and MeasuresThe powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy.ResultsA total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &lt; .001).Conclusion and RelevanceThe CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy.Trial RegistrationClinicalTrials.gov Identifier: NCT05132998

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Section: Discussionmentioning

confidence: 99%

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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“…20,41,42 Derangements in proinflammatory cytokines in older adults have been linked to multimorbidity. 41,43,44 MCR recovery is also gained increasing attention. Physical activity and executive function are considered the two main directions for recovery from MCR.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, inflammatory responses have been reported to be the pathological basis of MCR 20,41,42 . Derangements in pro‐inflammatory cytokines in older adults have been linked to multimorbidity 41,43,44 …”

Section: Discussionmentioning

confidence: 99%

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Xiong,

Wang,

Zhu

et al. 2023

Int J Geriat Psychiatry

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ObjectivesMotoric cognitive risk syndrome (MCR), a pre‐dementia syndrome, is characterized by slow gait and subjective cognitive complaints among older adults. This study assessed the relationship between multimorbidity, its patterns, and MCR.MethodsData for this study were obtained from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Participants who were aged 60 years and older and had complete data at baseline as well as complete data about MCR at follow‐up were selected. Patients without MCR at baseline were selected for further analyses. Longitudinal associations between multimorbidity, its patterns, and MCR were examined using a Cox proportional hazards model. Multimorbidity patterns were classified using latent class analysis.ResultsA total of 4923 respondents were included at baseline, 43.47% of whom had multimorbidity. Additionally, the prevalence of MCR at baseline was 12.61%. After adjusting for covariates, multimorbidity was positively associated with MCR (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.06–1.68). A higher number of multimorbidity was also significantly associated with an increased risk of developing MCR (HR = 1.10, 95% CI = 1.02–1.19). Three multimorbidity patterns were selected: relatively healthy pattern, respiratory pattern, and cardiovascular pattern. Older adults with the cardiovascular pattern were 1.57 times more likely to develop MCR than those with the relatively healthy pattern (HR = 1.57, 95% CI = 1.16–2.13). There was no significant difference between the relatively healthy pattern and the respiratory pattern (HR = 1.31, 95% CI = 0.91–1.92).ConclusionsMCR is highly prevalent among older Chinese adults. MCR may be exacerbated by multimorbidity. For older adults with multimorbidity (especially cardiovascular multimorbidity), attention should be paid to MCR to achieve early detection, diagnosis, and treatment.

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“…Cardiovascular diseases encompass a wide range of complications associated with the heart and blood vessels and have persisted as the number one cause of death in the world over the last 2 decades. 1 , 2 Narrowing of the blood vessels due to plaque buildup within the vessel walls, or atherosclerosis, is one of the most common complications associated with vascular diseases. This can lead to severe reductions in blood flow to downstream tissue or a complete blockage of blood flow from the heart.…”

Section: Introductionmentioning

confidence: 99%

Complement component C1q initiates extrinsic coagulation via the receptor for the globular head of C1q in adventitial fibroblasts and vascular smooth muscle cells

Freda

Ghebrehiwet

Rubenstein

2023

Immunity Inflam & Disease

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Background Vascular diseases are highly associated with inflammation and thrombosis. Elucidating links between these two processes may provide a clearer understanding of these diseases, allowing for the design of more effective treatments. The activation of complement component 1 (C1) is a crucial contributor to innate immunity and is associated with significant concentrations of circulating C1q. Many pathological pathways initiate when C1q interacts with gC1qR. This interaction plays a major role in inflammation observed during atherosclerosis and the initiation of intrinsic coagulation. However, the effects of C1 and the role of C1q/gC1qR on extrinsic coagulation, which is the more physiologically relevant coagulation arm, has not been studied. We hypothesized that C1q binding to gC1qR enhances the expression of tissue factor (TF) in adventitial fibroblasts and vascular smooth muscle cells, the primary TF bearing cells in the body. Methods Using an enzyme‐linked immunosorbent assay approach, TF expression and the role of gC1qR was observed. Cells were conditioned for 1 h with C1q or a gC1qR blocker and C1q, to assess the role of gC1qR. Additionally, cell growth characteristics were monitored to assess changes in viability and metabolic activity. Results Our results indicate that the expression of TF increased significantly after incubation with C1q as compared with unconditioned cells. Cells conditioned with gC1qR blockers and C1q exhibited no change in TF expression when compared with cells conditioned with the blocking antibodies alone. Our results show no significant differences in metabolic activity or cell viability under these conditions. Conclusions This indicates that gC1qR association with C1q induces TF expression and may initiate extrinsic coagulation. Overall, this data illustrates a role for C1q in the activation of extrinsic coagulation and that gC1qR activity may link inflammation and thrombosis.

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Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

Cited by 14 publications

References 51 publications

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Complement component C1q initiates extrinsic coagulation via the receptor for the globular head of C1q in adventitial fibroblasts and vascular smooth muscle cells

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