Survival With a Cost: Increased Long-Term Coronary Artery Disease Risk After Adjuvant Fluoropyrimidine Chemotherapy in Colorectal Cancer Survivors
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Background
Fluoropyrimidine-based chemotherapy, including 5-fluorouracil (5-FU) and capecitabine, is a cornerstone of adjuvant treatment in non-metastatic colorectal cancer (CRC). While acute cardiotoxicity is recognized, the long-term impact on coronary artery health remains poorly understood. This study aimed to determine whether CRC survivors treated with fluoropyrimidines exhibit a higher burden of coronary artery disease (CAD) years after therapy completion.
Methods
In this prospective, single-center study, CRC survivors five to seven years post-adjuvant 5-FU/capecitabine therapy (ChemT group) were compared with age- and sex-matched cancer-free controls undergoing elective coronary angiography (n=45/group). Clinical, laboratory, echocardiographic, and invasive angiographic parameters were systematically evaluated. The primary endpoint was the presence and anatomical distribution of significant CAD.
Results
Despite fewer anginal symptoms, ChemT patients had a significantly higher prevalence of CAD in the proximal left anterior descending artery (24% vs 2%, P =0.004) and proximal right coronary artery (13% vs 0%, P =0.026). Overall, 44% of ChemT patients required percutaneous coronary intervention versus 16% of controls ( P =0.006), with a greater number of stents implanted in the ChemT group. Notably, the ChemT cohort also demonstrated elevated LDL cholesterol, hepatic transaminases, and abnormal hematologic indices, suggestive of long-term metabolic and vascular stress. Echocardiography revealed no significant impairment in ejection fraction but altered left ventricular geometry in the ChemT group compared to controls.
Conclusions
CRC survivors treated with fluoropyrimidine-based chemotherapy exhibit a significantly elevated burden of anatomically high-risk coronary artery disease, particularly in proximal segments with poor prognostic implications. These findings highlight a silent but clinically significant cardiovascular risk in long-term cancer survivorship and support the need for proactive cardiac surveillance strategies in this population.
