Study reveals increased risk of premature heart failure in young cancer survivors

Heart failure is a global endemic issue and its incidence worldwide continues to increase despite several advances in the medical field over the last two decades. Heart failure is not only a problem that burdens the older age but can affect individuals at a younger age as well. 

A recent study published in the “Journal of American College of Cardiology” highlighted the increased prevalence of heart failure in young adults (18 to 39 years of age) who are cancer survivors and have previously received anthracycline-based chemotherapy. This study involving approximately 1300 patients quoted a 2.6-fold higher risk of developing heart failure in such individuals.

Increasing Incidence of Heart Failure Among Young Adults

With changing times, evolution in sedentary lifestyles, adoption of Western habits, shift in eating habits and increasing factors like stress, anxiety and obesity, heart diseases including heart failure have been on the rise even among the youth. Recent studies suggest that heart failure accounts for 10 per cent of cardiac transplants in the youth.  

Heart failure is a chronic condition which occurs when the heart is unable to pump blood sufficiently to meet the metabolic demands of the tissues in the body. A weakened heart results in inadequate blood supply to the cells leading to fatigue, shortness of breath and other symptoms of heart failure.  

Several factors can contribute to heart failure in young individuals, and it’s crucial to identify and address these causes for appropriate management and prevention. Here are some common causes of heart failure among youth:

•    Congenital Heart Defects: Congenital heart defects are structural abnormalities present at birth that affect the heart’s function. These defects can disrupt the normal flow of blood and strain the heart over time, potentially leading to heart failure.

•    Cardiomyopathies: Cardiomyopathies are diseases of the heart muscle that can weaken the heart’s ability to pump blood effectively. Dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy are examples of conditions that can affect young individuals.

•    Myocarditis: Myocarditis is inflammation of the heart muscle often caused by viral infections. Inflammation can weaken the heart and lead to heart failure, particularly in severe cases.

•    Genetic Factors: Some genetic conditions, such as familial dilated cardiomyopathy or specific genetic mutations, can predispose individuals to heart failure at a young age.

•    Drug or Substance Abuse: The use of certain drugs, including alcohol, cocaine, amphetamines, or even some prescription medications, can damage the heart and contribute to heart failure.

•    Autoimmune Disorders: Autoimmune diseases like lupus or rheumatoid arthritis can sometimes affect the heart and lead to inflammation or cardiomyopathy.

•    Infections: Certain infections, such as HIV or Chagas disease, can directly impact the heart muscle and contribute to heart failure in young individuals.

•    Toxic Exposures: Exposure to toxins, heavy metals, or radiation can harm the heart and may lead to heart failure.

•    Obesity: Obesity is a growing concern, and excessive weight can strain the heart and lead to conditions like hypertension and diabetes, which are risk factors for heart failure.

•    High Blood Pressure (Hypertension): Uncontrolled high blood pressure can damage the heart’s arteries and lead to heart failure, even in younger individuals.

•    Diabetes: Poorly managed diabetes can damage blood vessels and nerves, affecting the heart’s ability to function efficiently. 

Treatments for Heart Failure

Various methods and therapies are currently available for managing each stage of the condition. There have been remarkable advances in the field of medical treatment for heart failure over the last decade.  It remains a progressive condition, and with timely interventions, one can live a normal life. Hence, identifying it at an early stage can be the most beneficial.

Treatments for Advanced Heart Failure 

In the earlier stages, the treatment consists of medication and lifestyle changes while in the more advanced stages, cardiac transplant, or device implantation (such as pacemakers and implantable cardioverter defibrillators) becomes necessary for most patients. Heart transplant is often considered the ultimate destination therapy for end-stage advanced heart failure patients when the other treatment options have been exhausted. However, undergoing a transplant is dependent upon some external factors which may be beyond our control such as the availability of a donor organ, the increasing number of patients waiting for transplants and the patient’s medical condition.  

In such cases, advanced technological procedures like LVADs can offer a viable option for patients. An LVAD, short for left ventricular assist device, is a battery-powered mechanical pump designed to assist the heart’s left side and largest chamber in pumping blood. The long-term survival rates associated with LVADs are comparable to those of heart transplants, and patients often experience an enhanced quality of life after undergoing this procedure. As technology has progressed, LVADs have become increasingly cost-effective, efficient, and user-friendly.

Maintaining a Healthy Heart

Many young people with heart failure continue to lead active and fulfilling lives. Taking an active role in the management of their own condition, together with good support, helps to keep their heart under control. Bringing about positive changes to lifestyle, in areas such as maintaining a healthy weight, having a balanced diet, avoiding smoking and alcohol, and reducing stress will help manage symptoms, prevent progression, and improve quality of life. 

In conclusion, prioritising heart health remains pivotal for young individuals struggling with heart failure. Through proactive self-care, lifestyle enhancements, and steadfast support, they can continue to thrive and lead satisfying lives while effectively managing their condition. 

(Authored by Dr. Talha Meeran, Consultant Cardiologist in the Department of Advanced Cardiac Sciences and Heart Transplant at Sir H. N. Reliance Foundation Hospital and Research Centre)

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