Life after cancer: Tendency for blood clotting and impaired vascular function endanger women's hearts

Women who had cancer in childhood have a higher risk of developing heart and circulation problems. Dr. Marina Panova-Noeva, a scientist at the German Centre for Cardiovascular Research (DZHK) is investigating the molecular mechanisms responsible for this.

New research calls for more attention to childhood cancer

Women who had cancer in childhood have a higher risk of developing heart and circulation problems. Dr. Marina Panova-Noeva, a scientist at the German Centre for Cardiovascular Research (DZHK) is investigating the molecular mechanisms responsible for this.

Until menopause, women are better protected against cardiovascular disease than men. The hormone estrogen ensures this. The reverse is true for people who had cancer as a child. Here women have a higher risk of developing heart and circulation problems. Dr. Marina Panova-Noeva, a scientist at the German Centre for Cardiovascular Research (German acronym: DZHK) is investigating the molecular mechanisms responsible for this within the research group of Prof. Dr. Philipp Wild at the center in the Rhein-Main region, Germany. She has discovered that after cancer, only women suffer a combination of an increased tendency to blood clotting and impaired vascular function with such interaction putting women’s hearts into greater health risks.

Cancer in childhood is a drastic event. 84% of all children survive these serious diseases today. But defeating cancer at such a young age is not without consequences for the rest of their lives. In addition to the increased risk of developing a new tumor, these patients are almost five times more susceptible to cardiovascular disease than the rest of the population. Women are particularly affected by this. This is because chemo- and radiotherapy at a young age affects the hormonal system. Women, therefore, have less of the cardiovascular-protective estrogen. Dr. Panova-Noeva wants to understand more precisely which molecular processes in the body contribute to the increased risk. She has now discovered that an increased tendency to blood clotting and a deteriorated vascular function in women are related, and the research has tracked down one element of the disease-causing mechanisms. The scientist was unable to prove this connection in healthy people and men who had cancer as children.

Acting early

Blood’s tendency to clot and an affected vascular function are acknowledged warning signs of a potential thrombotic event. Examples of such may include a pulmonary embolism or thrombosis in the leg veins, or vessel calcification (arteriosclerosis), with the eventual development of coronary heart disease. "The group we researched was in the range of 20 to 45 years old, so we do not yet see the diseases themselves in these people, but rather subclinical changes such as increased blood coagulation potential or deteriorated vascular function," explains Prof. Dr. Wild. Such markers can be used to filter out who has increased cardiovascular risk and who does not. After all, not all women who had a tumor as a child are at risk. How well the vessel wall is doing can be assessed, for example, by measuring how stiff or elastic it is. "This gives us a continuous target value with which we can gradually assess the condition," explains Dr. Panova-Noeva.

"If such risk signals are detected early, they can be treated very well nowadays, so that cardiovascular diseases do not have to occur," says Prof. Dr. Wild. "So far, we have treated people who had cancer as children in the same way as people without cancer," he adds.

This is because five years after surviving cancer, patients are currently discharged as cured and then receive regular further treatment by their pediatricians or later general practitioners. This would mean that they would have to be examined much more closely at a young age, and thus much earlier than the rest of the population, with a greater focus placed on the occurrence of cardiovascular risk factors.

Source:
Relation between platelet coagulant and vascular function, sex-specific analysis in adult survivors of childhood cancer compared to a population-based sample. Panova-Noeva M, Wagner B, Nagler M, Arnold N, Prochaska JH, Eckerle S, Spronk HM, Merzenich H, Wingerter A, Schneider A, Danckwardt S, Ten Cate H, Faber J, Wild PS. Sci Rep. 2019 Dec 27;9(1):20090. https://doi.org/10.1038/s41598-019-56626-1

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