Sex-Specific Cardiovascular Risks of Cancer and Its Therapies

作者：Nicholas S. Wilcox, Seth J. Rotz, McKay Mullen, Evelyn J. Song, Betty Ky Hamilton, Javid Moslehi, Saro H. Armenian, Joseph C. Wu, June-Wha Rhee, Bonnie Ky · 发表于：Circulation Research · 年份：2022 · DOI：10.1161/circresaha.121.319901 · 被引用次数：85 · 研究领域：Chemotherapy-induced cardiotoxicity and mitigation、Acute Myocardial Infarction Research、Atherosclerosis and Cardiovascular Diseases

In both cardiovascular disease and cancer, there are established sex-based differences in prevalence and outcomes. Males and females may also differ in terms of risk of cardiotoxicity following cancer therapy, including heart failure, cardiomyopathy, atherosclerosis, thromboembolism, arrhythmias, and myocarditis. Here, we describe sex-based differences in the epidemiology and pathophysiology of cardiotoxicity associated with anthracyclines, hematopoietic stem cell transplant (HCT), hormone therapy and immune therapy. Relative to males, the risk of anthracycline-induced cardiotoxicity is higher in prepubertal females, lower in premenopausal females, and similar in postmenopausal females. For autologous hematopoietic cell transplant, several studies suggest an increased risk of late heart failure in female lymphoma patients, but sex-based differences have not been shown for allogeneic hematopoietic cell transplant. Hormone therapies including GnRH (gonadotropin-releasing hormone) modulators, androgen receptor antagonists, selective estrogen receptor modulators, and aromatase inhibitors are associated with cardiotoxicity, including arrhythmia and venous thromboembolism. However, sex-based differences have not yet been elucidated. Evaluation of sex differences in cardiotoxicity related to immune therapy is limited, in part, due to low participation of females in relevant clinical trials. However, some studies suggest that females are at increased risk of immune checkpoint inhibit...