Around 63 percent of people newly diagnosed with myeloma are also living with — or have a history of — heart disease. High rates of heart disease in those with myeloma may be associated with myeloma itself or side effects of myeloma treatment. The increased rates may also be related to age.
People being treated for multiple myeloma can take steps to manage or reduce the risk of developing heart disease, which is the leading cause of death in the United States.
Heart disease is a group of related conditions, also broadly referred to as cardiovascular disease, that involve the function of the heart and blood vessels. There are many forms of heart disease. The most common type is coronary artery disease, which affects nearly 7 percent of adults. Other forms of heart disease include:
Except for congenital heart disease, which is present at birth, heart disease is generally more common in older adults. Many aspects of lifestyle and health are associated with a higher risk of heart disease, including:
High blood pressure (hypertension), which can be genetic, is also a risk factor for developing heart disease.
It’s important to be aware of the symptoms of heart disease so you can recognize a problem if it develops. Symptoms of cardiovascular disease include:
Myeloma is frequently associated with cardiovascular comorbidities, or additional conditions that are present at the same time as the cancer. The high rate of people with both myeloma and heart disease is due in part because older adults are at an increased risk of both diseases.
Cardiovascular complications may be the result of myeloma itself. Myeloma often causes high levels of calcium in the blood, which can lead to arrhythmia. Additionally, myeloma can cause kidney failure, which has been associated with an increased risk of heart disease.
Several types of myeloma treatments have been associated with cardiac events, or heart-related problems.
Specific chemotherapy drugs known as anthracyclines can damage the heart muscle. Doxorubicin (Adriamycin) is an anthracycline used in the treatment of multiple myeloma. However, due to its side effects, this drug may not be recommended for people with a history of heart attack (myocardial infarction), arrhythmia, or heart failure.
Corticosteroids such as dexamethasone, which is used to treat multiple myeloma, can increase the likelihood of developing diabetes and high blood pressure. Both conditions are risk factors for heart disease.
Immunomodulatory agents are drugs that help the immune system recognize and attack cancer cells. Thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst) are immunomodulators that may increase the chance of cardiovascular complications, particularly when used together with dexamethasone. A person is more at risk of developing blood clots in the veins (deep vein thrombosis) or the lungs (pulmonary embolism) as a result of treatment with drugs in this category.
Proteasome inhibitors include the drugs carfilzomib (Kyprolis) and bortezomib (Velcade), which may be used in combination with chemotherapy. Carfilzomib, in particular, has been shown to cause a higher risk of cardiac events. Treatment with carfilzomib can cause heart damage, potentially leading to arrhythmia and heart failure.
In people with preexisting risk factors, treatment with radiation therapy can lead to an increased risk of heart disease.
People in treatment for multiple myeloma can take steps to manage complications of — or reduce the risk of developing — heart disease. Lifestyle habits such as eating a healthy diet and getting more exercise can improve cardiovascular disease symptoms.
While you’re undergoing myeloma treatment, be sure to get all recommended blood tests and screenings. These routine checks can catch any changes in cardiovascular risk and help prevent life-threatening cardiac events.
If you are dealing with symptoms of heart disease, your cancer care team should work with a cardiologist to help you choose the safest and most effective treatments for you. If your risk of heart problems changes, your myeloma treatment plan may need to change, too.
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