{
  "abstract": "Introduction Fluoropyrimidines such as 5-fluorouracil and capecitabine are routinely used as postoperative systemic therapy in patients with non-metastatic colorectal cancer (CRC). Although short-term cardiac adverse effects are well described, evidence regarding delayed coronary involvement is limited. This study evaluated whether individuals previously exposed to fluoropyrimidines demonstrate a greater extent of ischaemic coronary artery disease (CAD) several years following treatment.Methods This cross-sectional, 2 year, single-center study used invasive coronary angiography to detect the presence of CAD among ChemT (N=45) and control group patients (age, gender-matched, cancer-naïve (N=45). Clinical, laboratory, echocardiographic parameters, and presence and anatomical distribution of significant CAD were evaluated and compared between two groups.Results Coronary angiography in 90 patients (mean age 65±7 years; 60% male) identified significantly higher presence of CAD in CRC ChemT patient group compared to control: 80% vs. 55 % (p=0.013). 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). While many baseline characteristics were comparable between cohorts, CRC survivors exposed to fluoropyrimidine-based chemotherapy exhibited a higher burden of prediabetes, fatigue, NYHA functional limitation, and multiple cardiovascular risk factors, whereas untreated controls had higher rates of dyslipidemia, obesity, and angina symptoms. CRC ChemT patients had lower red blood cell count (4.45± 0.56 vs. 4.68± 0.50 x109/L; p=0.044), platelet count (214.18±50.99 vs. 201.00 ±156.40 x109/L; p=0.002) and white blood cell count (5.50 ±1.62 vs. 7.67±1.72 x109/L; p=0.000).Conclusions Colorectal cancer survivors exposed to fluoropyrimidine-based chemotherapy may have a higher burden of anatomically high-risk coronary artery disease, particularly involving proximal coronary segments associated with unfavourable prognosis, accompanied by long-term impairment in blood erythropoiesis and long-term metabolic and vascular stress, In line with ESC cardio-oncology principles, these findings support a risk-adapted approach to cardiovascular assessment and follow-up in long-term cancer survivors.",
  "authors": [
    {
      "affiliations": [
        "University Clinical Center, Tuzla, Bosnia and Herzegovina"
      ],
      "name": "Ivana Iveljic"
    },
    {
      "affiliations": [
        "University Clinical Center, Tuzla, Bosnia and Herzegovina"
      ],
      "name": "Lejla Alidzanovic Nurkanovic"
    },
    {
      "affiliations": [
        "William Harvey Research Institute, London, United Kingdom"
      ],
      "name": "Nay Aung"
    },
    {
      "affiliations": [
        "William Harvey Research Institute, London, United Kingdom"
      ],
      "name": "Dunja Aksentijevic"
    }
  ],
  "title": "143 Beyond cancer survival: elevated coronary artery disease risk after adjuvant fluoropyrimidine therapy",
  "uid": "6ff2241f-7f8e-572a-942b-0c84f20ec607"
}