All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- NOTE: You can make the print bigger with the font button on your browser! (It's usually a big "A") ----------------------------------------------------------- Staying on Meds When Heart Function Improves Jon's Note: This is all about people with weakened hearts caused by cancer treatment, but it points to the importance of ongoing therapy. ----------------------------------------------------------- November, 2003 - In this small study of cancer patients, all 8 patients had a normal EF before chemotherapy, with no heart failure symptoms. Average EF *after* chemotherapy was 25%, and all patients showed serious heart failure symptoms. They were treated with ACE inhibitors and beta-blockers, and their EFs significantly improved. Heart failure meds were then stopped. Two patients died within 2 months (one from sudden cardiac death). Two others were hospitalized for class 4 heart failure. One patient had a heart attack and one had a stroke. Another patient needed outpatient treatment for worsening heart failure. This study suggests that ACE inhibitors and beta- blockers should definitely be continued permanently even if heart function returns to normal. Title: Withdrawal of ACE-inhibitors and beta blockers in chemotherapy induced heart failure leads to severe adverse cardiovascular events. Authors: Lenihan D, Tong A, Woods M, et al. (MD Anderson Cancer Center, Houston, Texas). Source: Circulation 2003;108(Suppl IV):IV-665, Abstract 3024. Source: AHA Scientific Sessions presentation by Dr. Gregory Geisler, November 12, 2003 ======================================================== Stayin On Heart Failure Meds When Heart Function Improves Two reports from The University of Texas Anderson Cancer Center suggest that ACE inhibitors and beta-blockers should be given long-term to cancer patients who have chemotherapy-related heart failure. Withdrawal of these drugs can lead to worsening heart function, symptoms, and even death. The researchers also found that successful ongoing heart failure treatment can allow cancer patients to stay on cancer drugs they still need. In one report, 8 cancer patients with normal EF and no heart failure symptoms before chemotherapy were treated after their EFs fell to an average of 25% and they developed heart failure symptoms during chemotherapy. Treatment included ACE inhibitor and beta-blocker as tolerated. EF improved to an average of 53%. Heart failure therapy was then stopped. Within 8 weeks all patients had a significant heart-related event. Two patients died, 2 required hospitalization for class 4 heart failure, one had a heart attack, one had a stroke, and one needed outpatient therapy for heart failure. Another 5 patients with normal EF who were being treated with trastuzumab and doxorubicin for breast cancer developed heart failure with average EFs of 23%. The patients were treated with maximum tolerated doses of ACE inhibitor and beta-blocker. All five had improved EF to an average of 52%, and had no more symptoms. They were able to continue trastuzumab, which was never stopped. They were kept on ACE inhibitor and beta-blocker treatment, and their hearts remained stable. The researchers stress the importance of patients being able to continue with their cancer treatment uninterrupted. At the time of reporting, cancer was still controlled in all patients. Source: Medscape, Linda Brookes Source: J Card Fail. 2003;9(5 suppl):S77. Abstract 281. Authors: Giesler G, Lenihan D, Tong A, et al. Title: Withdrawal of ACE inhibitors and beta-blockers in cancer patients with congestive heart failure leads to severe cardiovascular adverse events. Source: J Card Fail. 2003;9(5 suppl):S102. Abstract 383. Authors: Lenihan D, Woods ML, Vooletich MT, et al. Title: Herceptin (trastuzumab)-associated cardiomyopathy: Sequential stress and response to ACE inhibitors and carvedilol therapy.