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J Am Coll Cardiol. 2019 Jul 30;74(4):567-577. doi: 10.1016/j.jacc.2019.06.007.

Clonal Hematopoiesis: Crossroads of Aging, Cardiovascular Disease, and Cancer: JACC Review Topic of the Week.

Author information

1
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: plibby@bwh.harvard.edu.
2
Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, New York.
3
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
4
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
5
Department of Internal Medicine IV, Division of Cardiology, J.W. Goethe-University, Frankfurt, Germany.
6
Department of Pathology, Stanford University, Stanford, California.
7
Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
8
Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.

Abstract

A novel, common, and potent cardiovascular risk factor has recently emerged: clonal hematopoiesis of indeterminate potential (CHIP). CHIP arises from somatic mutations in hematopoietic stem cells that yield clonal progeny of mutant leukocytes in blood. Individuals with CHIP have a doubled risk of coronary heart disease and ischemic stroke, and worsened heart failure outcomes independent of traditional cardiovascular risk factors. The recognition of CHIP as a nontraditional risk factor challenges specialists in hematology/oncology and cardiovascular medicine alike. Should we screen for CHIP? If so, in whom? How should we assess cardiovascular risk in people with CHIP? How should we manage the excess cardiovascular risk in the absence of an evidence base? This review explains CHIP, explores the clinical quandaries, strives to provide reasonable recommendations for the multidisciplinary management of cardiovascular risk in individuals with CHIP, and highlights current knowledge gaps.

KEYWORDS:

cancer; cardio-oncology; cardiovascular risk; leukemia; leukocyte

PMID:
31345432
PMCID:
PMC6681657
[Available on 2020-07-30]
DOI:
10.1016/j.jacc.2019.06.007

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