A state-of-the-art review, co-authored by Ky, looks at the evolving design of NIH-funded cardio-oncology studies to address cancer treatment-related cardiovascular toxicity. Another state-of-the-art review, authored by Ronald Witteles, MD, FACC, and Michaela Liedtke, MD, provides a review of AL amyloidosis for the cardiologist and oncologist. In a viewpoint article, Deepak L. Bhatt, MD, MPH, FACC, discusses the birth and maturation of cardio-oncology.

In the inaugural Editor's Page, Ky gives her guiding principles and vision for the journal. "Ultimately, JACC: CardioOncology is a tremendous opportunity to shape and transform the field of cardio-oncology into a mature field that focuses on scientific evidence, patient centeredness, community engagement, and multidisciplinary collaboration," she writes.

Visit JACC.org/CardioOncology to read the journal online and download the PDF of the first issue. Learn more about Dr. Ky and her plans for the journal in an interview published in June's issue of Cardiology at ACC.org/Cardiology.

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ACC and ASCO are similar specialty societies working towards improving outcomes for these patients.

"We stand shoulder to shoulder in the battle," Kovacs and Burris write. "We celebrate victories together and we mourn losses as colleagues. As we recognize the publication of the first edition of JACC: CardioOncology, we celebrate a new tool to aid in the fight: to publish new knowledge, to educate our members, to foster debate, and to advance the frontiers of this growing field. Ultimately, we strive to improve the quality of life for the patients we serve."

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The researchers examined exercise data collected at the visit closest to breast cancer diagnosis and that was between five years and one month prior to diagnosis. Metabolic equivalent task (MET) values were assigned for levels of physical activity per week and exercise was categorized in quartiles: <2.50 MET-hours/week (994 patients); 2.50 to ≥8.625 (1,008 patients); 8.625 to <18.0 (1,011 patients); and ≥18.0 (1,002 patients).

During the study, 324 cardiovascular events occurred. The researchers found that exercising prior to a breast cancer diagnosis was associated with a 20 to 37 percent reduction in the risk of first cardiovascular events. The risk of myocardial infarction and heart failure was not impacted, suggesting that exercise may be associated with a greater risk reduction in other cardiovascular events such as angina, coronary revascularization, peripheral artery disease or stroke. Individuals meeting current physical activity recommendations (9 MET-hours/week), prior to diagnosis had a 46 percent lower risk of coronary heart disease death compared with those who exercised less than recommended.

According to the authors, patients who were more physically active prior to breast cancer diagnosis are likely to have a more favorable cardiovascular profile, including higher cardiorespiratory fitness. These patients may have a higher cardiovascular reserve capacity to tolerate the cardiovascular toxic effects that are sometimes experienced as a side effect of cancer treatment. These patients are also more likely to be more active during cancer treatment, which has, in other studies, found to be associated with a lower risk of cardiovascular events.

"As more and more patients survive their breast cancer, cardiovascular disease is and will continue to become a major risk of morbidity and mortality for survivors," write Lindsay L. Peterson, MD, MSCR, and Jennifer A. Ligibel, MD, in an editorial comment accompanying the paper. "Finding strategies to help patients engage in recommended amounts of physical activity prior to and after breast cancer diagnosis will be critical to improving outcomes in women with early breast cancer, in particular in the rising number of older adults with breast cancer."

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