Diagnosis and Management of Cardiovascular Risk in Patients with Polycythemia Vera

• Published in: Vascular health and risk management Vol. 19; pp. 765 - 778
• Main Authors: Benevolo, Giulia, Marchetti, Monia, Melchio, Remo, Beggiato, Eloise, Sartori, Chiara, Biole, Carlo Alberto, Rapezzi, Davide, Bruno, Benedetto, Milan, Alberto
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 30.11.2023; Dove Medical Press
• Subjects: Apixaban; Aspirin; Blood clot; Cardiac patients; cardiovascular risk; Care and treatment; Complications and side effects; Heart attack; Hypertension; Medical research; Medicine, Experimental; Mortality; myeloproliferative neoplasms; Patient compliance; Pennsylvania; Polycythemia; polycythemia vera; Prevention; Risk factors; Thrombosis; Pennsylvania
• ISSN: 1178-2048; 1178-2048
• DOI: 10.2147/VHRM.S429995

Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by aberrant myeloid lineage hematopoiesis with excessive red blood cell and pro-inflammatory cytokine production. Patients with PV present with a range of thrombotic and hemorrhagic symptoms that affect quality of life and reduce overall survival expectancy. Thrombotic events, transformation into acute myeloid leukemia, and myelofibrosis are largely responsible for the observed mortality. Treatment of PV is thus primarily focused on symptom control and survival extension through the prevention of thrombosis and leukemic transformation. Patients with PV frequently experience thrombotic events and have elevated cardiovascular risk, including hypertension, dyslipidemias, obesity, and smoking, all of which negatively affect survival. To reduce the risk of thrombotic complications, PV therapy should aim to normalize hemoglobin, hematocrit, and leukocytosis and, in addition, identify and modify cardiovascular risk factors. Herein, we review what is currently known about the associated cardiovascular risk and propose strategies for diagnosing and managing patients with PV. Plain Language Summary: Patients with the myeloproliferative neoplasm (MPN) polycythemia vera (PV) are at increased risk of cardiovascular (CV) events, including stroke, heart attacks, and peripheral arterial disease. High blood pressure, smoking, and dyslipidemia are common in MPN and contribute to the increased cardiovascular risk. Effectively controlling cardiovascular risk factors in PV, along with appropriate hematological therapy such as direct-acting oral anticoagulants alone or in combination with aspirin, may improve the outcomes of patients with PV, but further research is needed. Keywords: cardiovascular risk, myeloproliferative neoplasms, polycythemia vera, thrombosis