Heart failure pharmacotherapy and cancer: pathways and pre-clinical/clinical evidence

Abstract Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prev...

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Published inEuropean heart journal Vol. 45; no. 14; pp. 1224 - 1240
Main Authors Sayour, Nabil V, Paál, Ágnes M, Ameri, Pietro, Meijers, Wouter C, Minotti, Giorgio, Andreadou, Ioanna, Lombardo, Antonella, Camilli, Massimiliano, Drexel, Heinz, Grove, Erik Lerkevang, Dan, Gheorghe Andrei, Ivanescu, Andreea, Semb, Anne Grete, Savarese, Gianluigi, Dobrev, Dobromir, Crea, Filippo, Kaski, Juan-Carlos, de Boer, Rudolf A, Ferdinandy, Péter, Varga, Zoltán V
Format Journal Article
LanguageEnglish
Published UK Oxford University Press 07.04.2024
Subjects
Heart Failure - drug therapy
Humans
Medicin och hälsovetenskap
Neoplasms - epidemiology
State of the Art Review
Heart failure
Mineralocorticoid Receptor antagonist
Beta-blocker
Cardio-oncology
Angiotensin-converting enzyme inhibitor
Sodium-glucose cotransporter 2 inhibitor
Angiotensin receptor blocker
Angiotensin receptor-neprilysin inhibitor
Cancer
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Abstract Abstract Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided. Graphical Abstract Graphical abstract The risk factors and pathophysiological pathways of both heart failure and cancer are common. The discipline of cardio-oncology investigates how heart failure and cancer progression are connected: on one hand, the cardiac effects of anti-cancer medications or cancer-derived metabolic byproducts are investigated, whereas on the other hand, the possible effects of heart failure on cancer progression are examined, such as those mediated by maladaptive neuroendocrine activation and factors secreted from the failing heart. Nevertheless, there is a lack of systematic knowledge on how heart failure pharmacotherapies affect new-onset cancer incidence or prevalent cancer outcomes, and whether these effects are mediated through the improvement in cardiac functions. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; MRA, mineralocorticoid receptor antagonist; SGLT2I, sodium-glucose cotransporter 2 inhibitor.
AbstractList Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided.
Abstract Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided.
Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided. Graphical abstract The risk factors and pathophysiological pathways of both heart failure and cancer are common. The discipline of cardio-oncology investigates how heart failure and cancer progression are connected: on one hand, the cardiac effects of anti-cancer medications or cancer-derived metabolic byproducts are investigated, whereas on the other hand, the possible effects of heart failure on cancer progression are examined, such as those mediated by maladaptive neuroendocrine activation and factors secreted from the failing heart. Nevertheless, there is a lack of systematic knowledge on how heart failure pharmacotherapies affect new-onset cancer incidence or prevalent cancer outcomes, and whether these effects are mediated through the improvement in cardiac functions. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; MRA, mineralocorticoid receptor antagonist; SGLT2I, sodium-glucose cotransporter 2 inhibitor.
Abstract Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided. Graphical Abstract Graphical abstract The risk factors and pathophysiological pathways of both heart failure and cancer are common. The discipline of cardio-oncology investigates how heart failure and cancer progression are connected: on one hand, the cardiac effects of anti-cancer medications or cancer-derived metabolic byproducts are investigated, whereas on the other hand, the possible effects of heart failure on cancer progression are examined, such as those mediated by maladaptive neuroendocrine activation and factors secreted from the failing heart. Nevertheless, there is a lack of systematic knowledge on how heart failure pharmacotherapies affect new-onset cancer incidence or prevalent cancer outcomes, and whether these effects are mediated through the improvement in cardiac functions. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; MRA, mineralocorticoid receptor antagonist; SGLT2I, sodium-glucose cotransporter 2 inhibitor.
Author Grove, Erik Lerkevang
Semb, Anne Grete
Camilli, Massimiliano
Paál, Ágnes M
Meijers, Wouter C
Savarese, Gianluigi
Dobrev, Dobromir
de Boer, Rudolf A
Varga, Zoltán V
Lombardo, Antonella
Dan, Gheorghe Andrei
Crea, Filippo
Minotti, Giorgio
Sayour, Nabil V
Ferdinandy, Péter
Ameri, Pietro
Andreadou, Ioanna
Ivanescu, Andreea
Drexel, Heinz
Kaski, Juan-Carlos
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  email: varga.zoltan@med.semmelweis-univ.hu
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crossref_primary_10_1093_eurheartj_ehae197
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ID FETCH-LOGICAL-c487t-7236020c2a361107cf03d7b34f7c2317d6dc909d425ee3ffb8332adbe05d37373
IEDL.DBID TOX
ISSN 0195-668X
1522-9645
IngestDate Wed Oct 02 03:54:16 EDT 2024
Tue Sep 17 21:28:25 EDT 2024
Sat Aug 17 05:24:53 EDT 2024
Thu Sep 12 17:22:11 EDT 2024
Sat Sep 28 08:11:53 EDT 2024
Wed Aug 28 03:15:40 EDT 2024
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 14
Keywords Heart failure
Mineralocorticoid Receptor antagonist
Beta-blocker
Cardio-oncology
Angiotensin-converting enzyme inhibitor
Sodium-glucose cotransporter 2 inhibitor
Angiotensin receptor blocker
Angiotensin receptor-neprilysin inhibitor
Cancer
Language English
License This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c487t-7236020c2a361107cf03d7b34f7c2317d6dc909d425ee3ffb8332adbe05d37373
Notes ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
Péter Ferdinandy and Zoltán V Varga contributed equally to this work.
ORCID 0000-0002-5678-6175
0000-0003-2236-2881
0000-0002-2940-5349
0000-0002-4775-9140
0000-0002-2758-0784
0000-0002-4612-117X
0000-0001-8068-0189
OpenAccessLink https://dx.doi.org/10.1093/eurheartj/ehae105
PMID 38441940
PQID 2937701156
PQPubID 23479
PageCount 17
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PublicationDate 2024-04-07
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  year: 2024
  text: 2024-04-07
  day: 07
PublicationDecade 2020
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PublicationTitle European heart journal
PublicationTitleAlternate Eur Heart J
PublicationYear 2024
Publisher Oxford University Press
Publisher_xml – name: Oxford University Press
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Snippet Abstract Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF....
Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both...
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SubjectTerms Heart Failure - drug therapy
Humans
Medicin och hälsovetenskap
Neoplasms - epidemiology
State of the Art Review
Title Heart failure pharmacotherapy and cancer: pathways and pre-clinical/clinical evidence
URI https://www.ncbi.nlm.nih.gov/pubmed/38441940
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