Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. It is characterized by the excessive accumulation of lymphocytes, a type of white blood cell, in the blood, bone marrow, lymph nodes, and spleen. CLL is typically a slow-progressing cancer, but it can have effects throughout the body, including potentially on the heart. Here we will examine the question of whether and how CLL can affect the heart.
Does CLL directly affect the heart?
CLL itself does not typically directly affect or damage the structure of the heart like some other cancers can. However, CLL does often cause changes in the composition of blood that can secondarily impact heart health and function.
The most direct way that CLL impacts the cardiovascular system is through anemia, which is a low red blood cell count. Anemia is common in CLL patients, affecting up to half of people at some point during the course of their disease. Red blood cells carry oxygen throughout the body. With fewer red blood cells circulating, body tissues like the heart muscle can become deprived of oxygen. This oxygen deprivation causes the heart to work harder to pump blood efficiently. The extra workload on the heart can lead to a range of cardiovascular problems if the anemia is severe or persistent.
Anemia in CLL
There are several reasons why anemia frequently occurs in CLL:
- The overcrowding of lymphocytes in the bone marrow can suppress normal red blood cell production (known as myelosuppression).
- CLL cells may cause inflammatory signals that lead to increased red blood cell destruction (hemolysis).
- The CLL cells themselves use up more of the body’s oxygen supply.
- CLL treatments like chemotherapy often cause anemia as a side effect.
The degree of anemia seen in CLL varies, but on average hemoglobin levels are approximately 2 g/dL below normal. Doctors monitor hemoglobin levels closely in CLL patients and treat anemia with medications, supplements, blood transfusions or growth factors as needed. Addressing anemia is an important part of managing cardiovascular health for CLL patients.
Indirect effects of CLL on the heart
In addition to anemia, CLL can affect the heart in more indirect ways related to the changes it causes in the immune system and inflammatory response. These include:
Risk of infection
CLL causes a depletion of normal, functioning lymphocytes. This suppressed immune system makes people more susceptible to infections. Certain infections like endocarditis (infection of the heart valves) can lead to severe heart damage if not treated quickly. Having CLL increases infection risk and the precautions needed to prevent infectious heart issues.
Chronic inflammation
CLL cells secrete substances that stimulate chronic inflammation in the body. Inflammation is linked to higher risks of cardiovascular diseases like atherosclerosis, blood clots, heart attacks, and strokes. Managing inflammation is an important part of CLL treatment.
Monoclonal antibodies
Many newer CLL treatments involve monoclonal antibodies – antibodies that target CLL cells. Some rare side effects of these monoclonal antibody infusions include heart arrhythmias and weakening of the heart muscle.
Fatigue
Fatigue is a common symptom in CLL patients, in part due to anemia. Fatigue and lower activity levels can contribute to weight gain and loss of fitness. Obesity and poor physical fitness in turn increase risks for heart disease. Staying active can help manage CLL-related fatigue and its cardiovascular effects.
Stress and depression
Being diagnosed with cancer and undergoing treatment can negatively impact mental health for many patients. Stress, anxiety and depression are more common in people with CLL. These mental health issues can sometimes manifest physically as higher blood pressure, irregular heart rhythms, and increased inflammation. Managing mental health is important for overall wellbeing and cardiovascular health.
CLL treatment effects on the heart
The treatments used for CLL can also impact the cardiovascular system, both positively and negatively:
Chemotherapy
Chemotherapy medications are designed to kill cancer cells but often affect healthy cells too. Chemotherapy agents can potentially damage the heart muscle leading to cardiomyopathy and heart failure. The risk depends on the specific drug, dosage and duration of treatment. Doctors monitor heart health during chemotherapy.
Some chemotherapy drugs also increase risk of arrhythmias and hypertension. Preventative medications help minimize chemo-related cardiovascular effects. Chemotherapy-induced anemia further increases demands on the heart. Blood transfusions can help improve oxygenation.
Targeted therapies
Newer targeted cancer therapies are designed to attack specific molecules or mechanisms in cancer cells. These smart drugs tend to have milder side effect profiles. However, as mentioned previously, monoclonal antibodies have a small risk of weakening the heart muscle or causing arrhythmias. Tyrosine kinase inhibitors used in CLL treatment can sometimes lead to high blood pressure. Doctors monitor blood pressure closely during treatment.
Radiation therapy
Although radiation is not often used to treat CLL, if lymph nodes in the chest are irradiated, this can inflame the sac around the heart (pericarditis) causing chest pain and fluid buildup. Pericarditis is usually mild and resolves after ending radiation treatment.
Stem cell transplants
For eligible younger patients with high-risk CLL, stem cell transplants offer the chance of long-term remission or cure. However, the pre-transplant chemotherapy conditioning does significant short-term damage to the heart and cardiovascular health must be carefully managed during and after transplant.
Supportive care
The supportive care therapies used to manage CLL symptoms and treatment side effects can also minimize impacts on the cardiovascular system. For example:
- Blood transfusions and growth factors to treat chemotherapy-induced anemia
- Anti-inflammatories and antibiotics to treat infections
- Blood pressure and cholesterol medications
- Antidepressants and therapy for mental health conditions
Aggressively monitoring and addressing side effects is an important part of protecting heart health during CLL treatment.
Monitoring heart health with CLL
Because of the potential effects of CLL and its treatment on the cardiovascular system, heart health should be carefully and regularly monitored. Important recommendations include:
- Routine blood tests to check for anemia and electrolyte imbalances
- Blood pressure monitoring at each clinic visit
- Cholesterol level assessment
- Echocardiograms or MUGA scans to evaluate heart function prior to and during treatments
- Electrocardiograms to check heart rhythm
- Being alert for any symptoms of arrhythmias, chest pain, fluid retention
Proactive monitoring allows cardiovascular side effects to be addressed quickly. Lifestyle measures like maintaining a healthy weight, exercising, not smoking, and managing stress are also important for supporting heart health.
Can you prevent CLL heart problems?
The best way to prevent CLL’s effects on the cardiovascular system is to treat the leukemia effectively. Obtaining early diagnosis and starting appropriate treatment helps reduce CLL complications. With modern targeted therapies, living with well-controlled CLL is possible for many patients.
That being said, heart-healthy lifestyle choices remain important during and after CLL treatment. Recommendations include:
- Quit smoking and avoid secondhand smoke exposure
- Eat a nutritious, low-salt, heart-healthy diet
- Stay active with regular moderate exercise within limits
- Aim for a healthy weight
- Manage stress through outlets like therapy, meditation, yoga
- Take medications for conditions like high blood pressure as prescribed
Good communication with your healthcare team allows proactive management of any cardiovascular effects, should they arise. Report any potential symptoms like chest pain, palpitations or breathing problems promptly. With vigilant monitoring and preventative care, CLL’s impacts on the heart can be minimized.
Key takeaways
In summary, while CLL does not intrinsically damage the heart muscle, it can affect the heart in secondary ways:
- Anemia caused by CLL places increased demands on the heart
- CLL may lead to increased inflammation and infection risk
- Cancer treatments like chemo have cardiovascular side effects
- Managing mental health is important for heart health
With treatment, monitoring, and healthy lifestyle choices the outlook for cardiovascular health is good for most CLL patients. Staying active and connected with your care team allows problems to be addressed proactively. The heart and CLL can coexist when the leukemia is well-controlled.
Conclusion
While CLL itself does not directly damage the structure of the heart, it can affect cardiovascular health in secondary ways related to anemia, inflammation, side effects of treatment, and impacts on mental health. With proactive monitoring, preventative care and early treatment of the leukemia, however, most CLL patients can manage effects on the heart and maintain good cardiovascular health. Open communication with your healthcare providers allows any potential issues to be caught early. Overall, living well with CLL and protecting the heart at the same time is very possible with an informed, empowered approach to care.