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KAMPALA – Results from a baseline study conducted among cancer patients at Uganda Cancer Institute have identified an aspect of cancer that requires enormous attention – the risk of cardiovascular diseases (CVDs). CVDs are a set of conditions that affect the heart and blood vessels such as stroke and coronary heart disease. The 15-months study dubbed: ‘Detecting Subclinical Anthracycline Related Cardiac Dysfunction in Low Income Countries’ (SATRACD) aimed to investigate the prevalence of CVD risk factors among Ugandan cancer patients. It’s the first of its kind to be done in Uganda.
SATRACD was conducted among 355 patients who were scheduled to receive anthracycline therapy (use of a certain class of drugs in cancer chemotherapy). Female patients and patients with breast cancer accounted for majority of patients studied.
Hypertension, obesity and HIV were identified as leading risk factors for CVDs among study participants. The patients, diagnosed with breast cancer, lymphomas, sarcoma, leukemia and liver cancer, were examined before receiving chemotherapy; immediately after and six months after the end of chemotherapy. Although hypertension was the most prevalent risk factor at 27%, it was not directly linked to any cancer.
Conversely, HIV and obesity which respectively accounted for 18% and 12% of the CVD risk factors were directly found to cause some cancers.
“While obesity has been a traditional risk factor for CVD, we are now seeing that it promotes cancer and breast cancer has been recognized as one of the obesity-associated cancers. About 54% of breast cancer patients in Uganda are either overweight or obese,” Dr. Wanzhu Zhang, the lead researcher and Cardiologist at Uganda Heart Institute (UHI) said in an interview.
More interestingly, obesity prevalence was strikingly higher among the cancer patients than in the local population.
Moreover, HIV-associated inflammation was identified as a major onset of cardiovascular risk, causing abnormal heart rhythms and even heart failure. Other risk factors identified include: alcohol use (20%); anemia (17%); smoking (1.1%); Diabetes (0.3%) and Chronic Kidney Disease (0.3%).
These findings show that a large proportion of certain cancer patients are at risk of developing heart problems such as blocked arteries and damage to small blood vessels if the risk factors are not quickly addressed. As long-term survival rates for cancer improve due to advancements in treatment, Dr. Zhang says it is critical to tackle CVD risk factors such as hypertension that may become significant years later.
“The high prevalence of cardiovascular risk factors among cancer patients calls for earlier, more aggressive and better coordinated cardiovascular care.
Knowing the CVD risks is the first step to improving cardiac care of cancer patients,” she cautioned.
Cancer Treatment & Heart Disease
The study also sought to identify the impact of anthracycline therapy on heart function. It reveals that the therapy poses dangerous heart problems to cancer patients because it not only affects the heart function directly but also weakens the ability of the heart do adapt other ‘stressors’ later in the life for example, a major operation, pregnancy and chest radiotherapy. Dr. Zhang notes that clinicians should closely monitor the heart function of cancer patients before and after chemotherapy.
On an individual basis, preventive strategies include regular medical check-up of blood pressure, diabetes and obesity; eating healthy diet and regular mild exercise.
Study Recommendations
Owing to the high prevalence of cardiovascular risk factors among cancer patients in Uganda, the study recommends the promotion of cardio-oncology practice, a new medical discipline that focuses on the detection, monitoring, and treatment of cardiovascular disease occurring as a side effect of chemotherapy and chest radiotherapy.
Additionally, there is need for health facilities to institute regular heart check-ups of cancer patients in order to detect heart problems early.
This research was supported by the NURTURE Research Training and Mentoring Program for Career Development at Makerere University’s College of Health Sciences (D43TW010132).
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