Journal: Circulation. Genomic and precision medicine
This publication reviews how clonal hematopoiesis (CH) presents in patients seen by cardiologists and how it should inform cardiovascular risk assessment and management.
Key points:
- Clinical contexts of detection: CH is identified in several settings relevant to cardio-oncology:
- • Incidentally during evaluation for cytopenias.
- • During workup for suspected germline cancer predisposition.
- • In patients with coexisting malignancies.
- • In post–cytotoxic therapy surveillance.
- Risk heterogeneity: Not all CH is equivalent. Cardiovascular risk is shaped by:
- • Clone features: larger variant allele fraction, multiple mutations, and the presence of specific driver genes (e.g., canonical CH drivers) increase risk.
- • Clinical context: age-related vs therapy-related CH behave differently; coexisting malignancy and prior cytotoxic exposure further modify risk.
- • Traditional cardiovascular factors: hypertension, hyperlipidemia, diabetes, smoking, and others interact with CH to influence ischemic events.
- Cardiovascular implications: Certain CH profiles, especially high-risk genotypes and larger clones, are associated with elevated risk of ischemic cardiovascular events and hematologic progression, necessitating closer cardiometabolic surveillance.
- Practical approach proposed:
- • Interpret CH in relation to how it was detected (incidental vs therapy-related vs malignancy-associated).
- • Integrate genomic data (clone size, number and type of mutations) with conventional cardiovascular risk stratification.
- • Use this integrated framework to personalize:
- • Cardiovascular evaluation intensity.
- • Aggressiveness of risk factor modification.
- • Consideration for enrollment in mechanistically targeted prevention trials.
Overall, the article argues that CH should be treated as a context-dependent, genomically defined cardiovascular risk modifier and outlines how cardiologists—especially in cardio-oncology—can incorporate CH characteristics into individualized risk mitigation strategies and clinical trial design.