In a nutshell
This paper reviewed the risk of heart disease in patients receiving treatment for multiple myeloma. Reducing the risk of heart disease is important in patients with multiple myeloma.
Some background
Multiple myeloma is a cancer of the plasma cells of blood. Treatment for multiple myeloma involves a group of drugs called proteasome inhibitors. Examples of such drugs are bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro). Steroids are also used for treatment. There is evidence to suggest that these treatments may increase the risk of cardiovascular (heart and blood vessel) complications.
Methods & findings
Initial studies comparing bortezomib and dexamethasone (a steroid) found no significant difference in the rate of heart failure. In a large study, bortezomib was not associated with an increased risk of heart damage or clots. Several studies have found that bortezomib had a lower rate of blood clots compared to dexamethasone.
Studies have found that survival without worsening disease was better in carfilzomib than bortezomib. However, up to 23% of patients who received carfilzomib had a heart-related complication. The ASPIRE study looked at patients who received carfilzomib or not. Patients who received carfilzomib had a higher risk of heart failure. The ENDEAVOR trial compared carfilzomib to bortezomib. 10.8% in patients who received carfilzomib had heart failure. 4.1% of patients who received bortezomib had heart failure. The FOCUS trial compared carfilzomib with steroid treatment. 5% of patients who received carfilzomib had heart failure. 1% of patients who received a steroid had heart failure.
Ixazomib is a new drug. In one study, there was no difference in the rate of heart-related complications in patients who received ixazomib or lenalidomide.
Drugs like lenalidomide and pomalidomide are associated with an increased risk of blood clots. Thus, it is suggested that patients at risk receive blood thinners when receiving these medications.
To prevent heart disease, patients should have their blood pressure and cholesterol optimized. Their blood sugar levels should also be well controlled. Patients should avoid smoking. Patients should also receive aspirin to prevent blood clots.
The bottom line
The authors concluded that multiple myeloma and its treatment increases the risk of heart disease.
Published By :
Current treatment options in cardiovascular medicine
Date :
Mar 06, 2018
