Just a few days out from getting a heart stent, I've been wondering why I, as a 45-year-old Caucasian Jew with no real history of heart disease in my family, had a blocked artery. My cholesterol has been an issue, but not so much as to cause this I firmly believe. I don't want to displace blame, but I am rather an unlikely victim on the whole, even though statistics suck when you're on the wrong side of them. A tiny bit of research finds that there's a more likely elevated risk factor that the cholesterol may have played into: radiation induced heart disease (RIHD).
Because there is now a large cohort of people who received radiation near the heart for previously harder-to-cure diseases and have survived for decades beyond that treatment, a previous suspicion now appears to be moving towards statistical confirmation. Radiation treatment, like the kind I received after chemotherapy for my Hodgkin's Disease, can increase the risk of heart disease in younger people and with otherwise lower profiles for such disease. (I'll take full responsibility for any risk I could have reduced, and will take full responsibility in the future for keeping those risks low that are in my control.)
My doctors 15 years ago, and my current G.P. and other practitioners I see aren't at fault in the least for not telling me about this. It's a growing body of knowledge, not fully confirmed, and recent in its increased certainty. Once you're released from routine oncology follow-ups, you're a bit on your own. This is another reason for integrated medicine across many specialties and practices: cancer needs a 50-year follow-up, not just up to a 5-year one.
I suspect the advice today for someone like me is: "You're going to need to be squeaky clean on any factors, like cholesterol, that would otherwise increase your risk, and you need to get a cardiologist and see him or her regularly to keep apprised of whether you're approaching the need for an intervention." That's what I plan from now on.
In fact, I don't have to speculate because as I write this post, I found that the European Association of Cardiovascular Imaging of the European
Society of Cardiology and the American Society of Echocardiography (deep breath) released a statement today from an experts panel saying that all patients who received chest radiation in the past should be evaluated, and that new patients should receive long-term follow-up and future evaluation at regular intervals.
I was told 15 years ago that radiation of the kind I got, relatively limited in dosage and area exposed, would dramatically reduce my odds of recurrence, and that has I believe played out in studies as well. I was also told that radiation treatment increases your risk slightly for contracting another form of cancer in the future, but the tradeoff of no recurrence today for a low-probability new form decades hence seemed like a good tradeoff and still does. You want to beat the cancer you have.
If you've had radiation therapy or know someone who has, I hope you'll view this as a bit of good news: you might be able to forestall the progression of disease or, at the very least, be well aware of when an intervention is needed and prepare for it. Don't freak out (or freak them out), but a consultation can be as simple as an EKG or much more involved. It can save your life or that of a loved one, or even just improve your or their lives.
The stent is a magical thing, and I'm glad to have it, and we are not anywhere near done with new repairs for the heart and its arteries, up to and including artificially grown (or even printed) heart tissue and full hearts.
I'm glad I live in the future. The past is a scary place.