Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention.
Radiother Oncol. 2010 Sep 6;
Authors: Andratschke N, Maurer J, Molls M, Trott KR
The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand – in close co-operation with mechanistic in vivo research studies – clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation.
20826032
– Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of…
Improving cardiovascular risk reduction for primary prevention-utility of lifetime risk assessment.
Postgrad Med. 2010 Jul;122(4):192-9
Authors: Elward KS, Simpson RJ, Mendys P
The objective of this article is to review the evidence basis for short-term risk assessments of overall coronary heart disease (CHD) burden as compared with lifetime risk estimates of CHD, based on the current medical literature. We reviewed literature published in the last 6 years using the terms “cardiovascular prevention,” “Framingham risk scoring,” “lifetime risk,” and “cardiovascular risk assessment,” and subsequently evaluated 98 publications to determine the variation in these approaches to estimate cardiovascular risk factors and impact on clinical decision making. The current evidence base suggests that lifetime risk estimates offset the significant impact of age on traditional, short-term risk estimates of cardiovascular risk. We conclude that the use of lifetime risk estimates may be more clinically meaningful than traditional, short-term risk estimates to assess an individual’s overall risk burden, and may prevent the potential delay of therapeutic interventions to reduce cardiovascular events. For primary care, this difference may be of relevance to patients and should be communicated to them.
20675982
…more
Clinical Inquiries: Does red wine reduce cardiovascular risks?
J Fam Pract. 2010 Jul;59(7):406-7
Authors: Lin JK, Kelsberg G, Safranek S
yes. Moderate daily red wine consumption decreases cardiovascular risk compared with either abstinence or heavy and binge drinking (strength of recommendation [SOR]: B, meta-analysis of prospective cohort and case-control studies); however, not enough evidence exists to determine whether wine reduces cardiovascular risk more than other alcoholic beverages. A high dietary intake of fl avonoids, contained in red wine and other food products, correlates with decreased mortality from coronary heart disease (CHD) (SOR: B, meta-analysis of prospective cohort studies). Heavy alcohol drinking is associated with an increased risk of stroke, but data are lacking for low and moderate levels of wine consumption. (SOR: B, meta-analysis of prospective cohort and case-control studies).
20625571
…more
