Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions

Cardiovascular disease and cancer are leading contributors to the global disease burden. As a result of cancer therapy-related cardiotoxicities, cardiovascular disease results in significant morbidity and mortality in cancer survivors and patients with active cancer. There is an unmet need for manag...

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Autores principales:	Jun Hua Chong, Arjun K Ghosh
Formato:	article
Lenguaje:	EN
Publicado:	Radcliffe Medical Media 2019
Materias:	Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/f5a2b4543738469f905137892fe9cd1e
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spelling	oai:doaj.org-article:f5a2b4543738469f905137892fe9cd1e2021-12-04T16:01:32ZCoronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions10.15420/icr.2019.121756-14851756-1477https://doaj.org/article/f5a2b4543738469f905137892fe9cd1e2019-05-01T00:00:00Zhttps://www.icrjournal.com/articleindex/icr.2019.12https://doaj.org/toc/1756-1477https://doaj.org/toc/1756-1485Cardiovascular disease and cancer are leading contributors to the global disease burden. As a result of cancer therapy-related cardiotoxicities, cardiovascular disease results in significant morbidity and mortality in cancer survivors and patients with active cancer. There is an unmet need for management of cardio-oncology conditions, which is predicted to reach epidemic proportions, and better understanding of their pathophysiology and treatment is urgently required. The proposed mechanisms underlying cardiotoxicity induced by 5-fluorouracil (5-FU) are vascular endothelial damage followed by thrombus formation, ischaemia secondary to coronary artery vasospasm, direct toxicity on myocardium and thrombogenicity. In patients with angina and electrocardiographic evidence of myocardial ischaemia due to chemotherapy-related coronary artery vasospasm, termination of chemotherapy and administration of calcium channel blockers or nitrates can improve ischaemic symptoms. However, coronary artery vasospasm can reoccur with 5-FU re-administration with limited effectiveness of vasodilator prophylaxis observed. While pre-existing coronary artery disease may increase the ischaemic potential of 5-FU, cardiovascular risk factors do not appear to completely predict the development of cardiac complications. Pharmacogenomic studies and genetic profiling may help predict the occurrence and streamline the treatment of 5-FU-induced coronary artery vasospasm. Echocardiographic measures such as the Tei index may help detect subclinical 5-FU cardiotoxicity. Further research is required to explore the cardioprotective effect of agents such as coenzyme complex, GLP-1 analogues and degradation inhibitors on 5-FU-induced coronary artery vasospasm.Jun Hua ChongArjun K GhoshRadcliffe Medical MediaarticleSurgeryRD1-811Diseases of the circulatory (Cardiovascular) systemRC666-701ENInterventional Cardiology: Reviews, Research, Resources, Vol 14, Iss 2, Pp 89-94 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701 Jun Hua Chong Arjun K Ghosh Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
description	Cardiovascular disease and cancer are leading contributors to the global disease burden. As a result of cancer therapy-related cardiotoxicities, cardiovascular disease results in significant morbidity and mortality in cancer survivors and patients with active cancer. There is an unmet need for management of cardio-oncology conditions, which is predicted to reach epidemic proportions, and better understanding of their pathophysiology and treatment is urgently required. The proposed mechanisms underlying cardiotoxicity induced by 5-fluorouracil (5-FU) are vascular endothelial damage followed by thrombus formation, ischaemia secondary to coronary artery vasospasm, direct toxicity on myocardium and thrombogenicity. In patients with angina and electrocardiographic evidence of myocardial ischaemia due to chemotherapy-related coronary artery vasospasm, termination of chemotherapy and administration of calcium channel blockers or nitrates can improve ischaemic symptoms. However, coronary artery vasospasm can reoccur with 5-FU re-administration with limited effectiveness of vasodilator prophylaxis observed. While pre-existing coronary artery disease may increase the ischaemic potential of 5-FU, cardiovascular risk factors do not appear to completely predict the development of cardiac complications. Pharmacogenomic studies and genetic profiling may help predict the occurrence and streamline the treatment of 5-FU-induced coronary artery vasospasm. Echocardiographic measures such as the Tei index may help detect subclinical 5-FU cardiotoxicity. Further research is required to explore the cardioprotective effect of agents such as coenzyme complex, GLP-1 analogues and degradation inhibitors on 5-FU-induced coronary artery vasospasm.
format	article
author	Jun Hua Chong Arjun K Ghosh
author_facet	Jun Hua Chong Arjun K Ghosh
author_sort	Jun Hua Chong
title	Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
title_short	Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
title_full	Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
title_fullStr	Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
title_full_unstemmed	Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions
title_sort	coronary artery vasospasm induced by 5-fluorouracil: proposed mechanisms, existing management options and future directions
publisher	Radcliffe Medical Media
publishDate	2019
url	https://doaj.org/article/f5a2b4543738469f905137892fe9cd1e
work_keys_str_mv	AT junhuachong coronaryarteryvasospasminducedby5fluorouracilproposedmechanismsexistingmanagementoptionsandfuturedirections AT arjunkghosh coronaryarteryvasospasminducedby5fluorouracilproposedmechanismsexistingmanagementoptionsandfuturedirections
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Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions

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