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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postmenopausal women in Western societies are conscious of breast cancer as a potential cause of death and ill health, which they wish to avoid with the advice of their doctors. Yet many factors that predispose women to the development of cancer will have been laid down before the menopause, in their genetic makeup or during their adolescent years. Even in middle age it is important to take account of the intrinsic level of risk, and to give women advice tailored to their own individual risk level. This results from their family history, previous diseases such as benign breast disease, and previous treatment for breast cancer or Hodgkin's disease. For those at the highest level of risk, strategies will include regular screening, prophylactic mastectomy, and the use of chemoprevention agents, such as tamoxifen. These women should avoid hormone replacement therapy (HRT) and control their menopausal symptoms and osteoporosis through the use of other agents now available - venlafaxine for menopausal symptoms and bisphosphonates for osteoporosis. Raloxifene is an agent under trial that may be valuable for breast cancer control as well as for osteoporosis. Women at standard population risk will require less robust preventive strategies, which will include screening and lifestyle modification. Their decisions regarding HRT should now be modified by recent evidence of associated risks. Recent studies show that tibolone causes less mammographic density and has a lower relative risk of breast cancer than combined estrogen/progestogen preparations. There is limited evidence that controlling obesity, participating in exercise and adopting a diet low in fats and high in fruit and vegetables will alter risk at this age. These precautions will, however, reduce the risk of other diseases common in this age group, such as hypertension, heart disease, stroke, and type 2 diabetes mellitus. Alcohol, even in small amounts, is a risk factor for breast cancer. Given the cardioprotective effect of moderate alcohol intake, advice on alcohol must reflect the individual relative risk of cardiovascular disease and breast cancer. Personal risk assessment is relevant for all women. Screening and a healthy lifestyle are worthwhile approaches for all, with the more aggressive approaches such as chemoprevention and prophylactic surgery reserved for those who have substantially elevated levels of risk. Once the menopause has passed, screening is probably the most effective evidence-based tool for breast cancer control by early diagnosis.
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PMID:Strategies for managing breast cancer risk after the menopause. 1533 Jun 77

Mitoxantrone has a broad anti-tumour activity including lymphoma with potentially less cardiotoxicity than doxorubicin, which may be of particular importance in elderly patients. However, an important issue is whether mitoxantrone is as efficacious as doxorubicin in the treatment of aggressive lymphomas. Through search of several relevant databases and contacts with lymphoma investigators worldwide, we identified nine randomised studies of previously untreated patients comparing CHOP and CNOP chemotherapy in aggressive non-Hodgkin lymphoma. Five trials were included where doxorubicin (50 mg/m2) was compared with mitoxantrone (10-12 mg/m2) and the interval between chemotherapy courses was 3-4 wk. In none of these trials rituximab was used. Odds ratios of complete remission (CR) were pooled using a fixed effects model, and odds ratios of overall survival (OS) were pooled using a random effects model. CNOP was significantly inferior to CHOP with regard to CR rate. CNOP was also inferior, but not significantly to CHOP with regard to OS. No formal testing of side effects could be made. However, the two regimens were equally myelosuppressive. Clinical evidence of symptomatic congestive heart disease was not more frequent among patients treated with CHOP. However, gastrointestinal toxicities and alopecia were more common in this group. CHOP chemotherapy is more efficacious than CNOP at equitoxic (myelosuppression) doses. CHOP is, however, associated with more alopecia and gastrointestinal toxicity.
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PMID:CNOP (mitoxantrone) chemotherapy is inferior to CHOP (doxorubicin) in the treatment of patients with aggressive non-Hodgkin lymphoma (meta-analysis). 1833 1

This paper reviews epidemiologic studies of cancer among agricultural populations to identify possible associations and to provide a focus for future investigations. Meta-analyses of mortality surveys of farmers find excesses of several cancers, including connective tissue, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma and cancers of the skin, stomach, and brain, and deficits for total mortality, heart disease, total cancer, and cancers of the esophagus, colon, lung, and bladder. Meta-analyses of studies of individual cancers also support these findings, indicating a need to identify exposures and lifestyle factors that might account for this mortality pattern. Although cancer studies of other occupations that might have pesticide exposures in common with farmers show some similarities with observations among farmers, the overall patterns are quite different. This suggests that pesticides are not likely to fully explain the cancer and other disease patterns observed among farmers. Because exposures vary by type of farm operation, exposures for individual farmers can differ considerably. Studies in the future need to focus on the full range of exposures to fully understand the cancer pattern in farmers.
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PMID:Epidemiologic studies in agricultural populations: observations and future directions. 1943 68

Rheumatoid arthritis (RA) is a systemic disease of unknown etiology characterized by a chronic inflammatory process mainly leading to destruction of synovial membrane of small and major diarthrodial joints. The prevalence of RA within the general adult population is about 1% and female subjects in fertile age result mostly involved. It's an invalidating disease, associated with changes in life quality and a reduced life expectancy. Moreover, we can observe an increased mortality rate in this population early after the onset of the disease. The mortality excess can be partially due to infective, gastrointestinal, renal or pulmonary complications and malignancy (mainly lung cancer and non-Hodgkin lymphoma). Among extra-articular complications, cardiovascular (CV) involvement represents one of the leading causes of morbidity and mortality. Every cardiac structure can be affected by different pathogenic pathways: heart valves, conduction system, myocardium, endocardium, pericardium and coronary arteries. Consequently, different clinical manifestations can be detected, including: pericarditis, myocarditis, myocardial fibrosis, arrhythmias, alterations of conduction system, coronaropathies and ischemic cardiopathy, valvular disease, pulmonary hypertension and heart failure. Considering that early cardiac involvement negatively affects the prognosis, it is mandatory to identify high CV risk RA patients to better define long-term management of this population.
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PMID:[Cardiac involvement in rheumatoid arthritis]. 2014 1

Primary lymphoma of the gallbladder is extremely rare. We present an asymptomatic case of primary combined DLBCL--MALT lymphoma of the gallbladder in a 78-year-old man in whom definitive diagnosis was made with laparotomic cholecystectomy. Preoperative diagnosis was supported by NMR, CT and PET scans. The pathological report identified a polypoid lesion measuring 3.5 cm in diameter. A non-Hodgkin lymphoma with two different coexisting patterns was identified histologically: large diffuse B-cell lymphoma (DLBCL) associated with focal areas of extranodal marginal zone B-cell lymphoma (MALT-type) of the gallbladder. The postoperative course was uneventful and the patient is currently without clinical or radiological signs of disease. Chemotherapy was not indicated due to cardiopathy. In conclusion, a primary gallbladder lymphoma is a rare entity. Radiological findings may be helpful, but cholecistectomy may be necessary for definitive diagnosis. In this report, we describe the possible association between MALT and DLBCL of the gallbladder.
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PMID:Simultaneous occurrence of primary diffuse large B-cell lymphoma and extranodal marginal zone (MALT) B-cell lymphoma in the gallbladder: a case report. 2038 9

The risk of cardiac hospitalization (CH) in Hodgkin lymphoma (HL) patients with preexisting heart disease was evaluated. Patients with HL were identified from a population-based registry (N = 3964). Data were abstracted from records of a randomly selected subcohort (N = 1096). A population-based registry was used to identify CH. Factors associated with CH and the incidence of CH after HL were estimated with competing risk models. Preexisting heart disease was the strongest predictor of posttreatment CH (hazard ratio = 3.98, P < .001) and significantly modified (P = .01) the effect of treatment on the risk of CH. Among patients with preexisting heart disease, treatment with mediastinal radiation therapy plus doxorubicin-based chemotherapy was associated with a 10-year incidence of CH more than 20% higher than treatment with chemotherapy alone. There is a high risk of CH after mediastinal radiation therapy plus doxorubicin-based chemotherapy among patients with preexisting heart disease; this is an important consideration when weighing treatment options, and in the follow-up of these patients.
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PMID:A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease. 2059 18

Hodgkin's disease can be cured in most cases by radiotherapy. However, it can increase the risk of cardiotoxicity. Here, we report a patient with Hodgkin's disease and superior vena cava syndrome who was treated with chemotherapy in combination with radiotherapy. Four months after the initiation of this therapy, she developed progressive dyspnea. Pleural and pericardial effusion, severe mitral regurgitation, moderate aortic insufficiency, and mild tricuspid regurgitation were detected in echocardiography, which suggested heart failure. The patient was then treated with intrapericardial drainage and received dopamine and diuretics for congestive heart failure; she responded well to this treatment and was discharged in good condition. After high-dose mediastinal radiation, cardiologic screening is recommended in order to identify patients with radiation-induced heart disease and to assess their need for treatment and follow-up.
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PMID:Severe valvular toxicity and pericarditis early after radiation therapy in a patient treated for Hodgkin's lymphoma. 2104 92

Advances in the treatment of Hodgkin lymphoma since about 1970 have led to a remarkable improvement in the long-term outcomes of what was once considered an incurable disease. The prolonged survival of cured patients has revealed new issues concerning the toxicity of successful therapy, however, including an increased risk of secondary malignancies and end-organ damage such as heart disease. This concern has led to the clinical research question of whether the de-escalation of treatment intensity could allow high cure rates to continue with less long-term toxicity. In young patients with favorable early-stage disease, the challenge has been to use systemic therapy while omitting radiation therapy as part of the initial treatment. This review briefly summarizes past data and updates readers regarding recent publications on this topic.
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PMID:Can low-risk, early-stage patients with Hodgkin lymphoma be spared radiotherapy? 2150 34

Extended-field and subtotal nodal radiation therapy (RT), developed in the 1960s, was the first reliably curative treatment for early-stage Hodgkin lymphoma (HL). However, the large volume of normal tissue irradiated resulted in significant delayed toxicity, including cardiac disease and second cancers (SCs). The 30-year cumulative incidence of heart disease among adult survivors receiving 40-45 Gy of extended-field or mantle RT is approximately 30%; the incidence of SCs is similar. Improving disease control while reducing the toxicity of treatment has been a major objective of HL trials for more than 2 decades. Contemporary involved-field RT (IFRT) reduces irradiated volumes and produces significant reductions in normal tissue dose compared with historic treatments. Recent data indicate that, compared with mantle RT, IFRT reduces the relative risk of breast cancer among young females receiving mediastinal RT by approximately 60% and also reduces cardiac dose. The recent transition to involved-node RT allows further reductions in normal tissue dose. Response-adapted therapy is being evaluated in clinical trials as a means of identifying those patients most likely to benefit from treatment reduction or intensification, enhanced screening will facilitate early intervention to reduce the clinical burden of late effects, and there is increasing interest in elucidating the genetic correlates of treatment toxicity.
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PMID:Late effects in the era of modern therapy for Hodgkin lymphoma. 2216 53

Radiation-induced heart disease (RIHD) is becoming an increasing concern for patients and clinicians alike as the use of radiation therapy for the treatment of certain malignancies increases, and patient mortality secondary to neoplasms of the thorax, in particular Hodgkin's lymphoma and breast cancer, decreases. The spectrum of pathology affecting the heart spans from acute to chronic and can affect almost all facets of the heart, including but not restricted to the pericardial sac, coronary arteries, myocardium, and heart valves. Significant research has been conducted over the past 40 years to further understand the toxic effects of radiation therapy and those protective methods that could curtail these adverse reactions. This article will focus on RIHD, the pathophysiological mechanisms for RIHD, the clinical presentations, and current and future directions for attempting to reduce the incidence of this condition.
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PMID:Radiation-induced heart disease. 2231 40


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