Women's Heart Advisor January 2019 Issue

Ask The Doctors: January 2019

Q: I recently read about a possible connection between endometrial cancer and heart disease. Would you please explain this? I'm a 3-year survivor of endometrial cancer, and I don't want another serious medical problem!

First, congratulations on beating your cancer. After everything you have been through, it must be frustrating to learn you are at risk of developing a different disease. To answer your question, the connection between heart disease and endometrial cancer is not due to the diseases themselves, but to the treatments that cured your cancer.

Last year, researchers looked at cardiovascular outcomes in more than 2,600 endometrial cancer survivors and found almost 28 percent were diagnosed with heart disease five to 10 years later. They were 33 percent more likely to develop heart disease than the general female population, but only if they had undergone radiation or chemotherapy. Patients who had been treated with surgery alone were not at increased risk.

Endometrial cancer survivors were 47 percent more likely than cancer-free peers to develop diseases of the blood vessels, veins and lymph system or hypertension within one to five years. More specifically, they were at increased risk of developing atherosclerosis in the arteries and veins of their legs and lungs, blood clots and atrial fibrillation in the first five years.

This was the first study to show an increased risk for hypertension among endometrial cancer survivors. The risk was highest in patients who were older, overweight, obese or burdened with other chronic diseases.

This is not the first time cancer treatments have been implicated in the development of heart disease. Anthracycline chemotherapy agents and radiation to the chest are known to cause heart failure. Risk is highest when both treatments are used.

Your doctor is doing the right thing by pinpointing any cardiovascular risk factors you have. By not smoking, getting daily physical activity, normalizing your weight, eating a heart-healthy diet and keeping your blood sugar, cholesterol and blood pressure levels under control, you will lower your risk of developing heart disease and another cancer, as well.

Q: In the last month, I was hospitalized with severe chest pain. A cardiac catheterization did not show any reason for it, and my doctors can't seem to find what's causing it. What should I do next?

The type of chest pain known as angina is associated with inadequate blood flow through the coronary arteries due to fatty blockages called plaques. Many blockages can be seen on angiograms taken during a cardiac catheterization. However, those occurring in very small arteries may not appear on angiography, yet may cause angina (microvascular angina). Angina can also occur when plaque-free arteries spasm (vasospastic angina). Both types of angina are more common in women than in men.

Microvascular angina and vasospastic angina are difficult to diagnose. It is not uncommon for patients to undergo testing for years without learning the reason for their chest pain. However, specific tests done in major heart centers can be used to diagnose these conditions. Accurate diagnosis is important, because these conditions are treated differently.

The gold standard for diagnosing microvessel disease is the measurement of coronary flow reserve (CFR), which is an invasive test done in the cardiac cath lab. Blood flow is measured at rest, then vasodilators are given and blood flow is measured again. Microvessel disease can also be diagnosed with positron-emission tomography (PET) scanning or cardiac magnetic resonance imaging (MRI). These tests should be done at facilities with extensive expertise in diagnosing microvessel disease, since they require special protocols to be used.

Once microvessel disease is confirmed, the underlying cause-endothelial dysfunction-is treated with aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and cardiac rehabilitation. Symptoms are treated with long-acting nitroglycerin, calcium channel blockers, beta blockers or ranolazine (RanexaŽ). Nitroglycerin tablets are provided for acute chest pain relief.

Coronary vasospasm can be diagnosed with a test that uses a medication to trigger the spasms. The treatment of choice is long-acting nitroglycerin (ImdurŽ) and a calcium channel blocker. Acute chest pain can be treated with sublingual nitroglycerin.

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