Radiotherapy, chemotherapy and atherosclerosis.

PURPOSE OF REVIEW: This article reviews the effects of radiotherapy and chemotherapy in promoting the progression of atherosclerosis in patients with cancer. RECENT FINDINGS: Radiotherapy is associated with an increase in the incidence of atherosclerosis with the effects being related to the site of irradiation and dose of radiotherapy. Cranial irradiation is associated with dyslipidaemia and the metabolic syndrome secondary to effect on growth hormone secretion. Chemotherapeutic oncological therapies are associated with numerous cardiac diseases including valve disease, pericarditis and cardiomyopathy but can also promote atherosclerosis. Therapies directed against vascular endothelial growth factor including tyrosine kinase inhibitors have a direct effect in raising blood pressure and increase rates of cardiovascular disease (CVD) events. Antimetabolites such as 5-fluorouraciland capecitabine cause chest pain and increase CVD events. Anthracyclines cause heart failure and may increase CVD risk. SUMMARY: There is increasing evidence that radiotherapy and some chemotherapeutic agents are associated with increased rates of CVD. Patients who have received treatment for cancer should be considered at higher risk of developing atherosclerosis and require increased monitoring, further investigation and earlier treatment than would be suggested by classical risk factor management strategies.

Venous thromboembolism prevention post neck of femur fractures - does it make a difference?

Neck of femur fractures predispose patients to venous thromboembolism (VTE). NICE has issued guideline 46 to reduce this risk through the use of antithrombic agents. We audited our department's VTE practise by reviewing the clinical notes of 123 consecutive patients with no exclusions. We found our compliance to be a low 6%. We also found that patients were likely to be given low molecular heparin (LMWH) only during their hospital stay. Reasons for the low adherence were probably secondary to confusion caused by the multiple thromboprophylaxis protocols used in our department. The correlation between duration of heparin administration and length of hospital stay was due to logistical difficulty in administering VTE prophylaxis out of hospital setting.