Predicting and preventing the cardiotoxicity of cancer therapy

For the past 40 years, cardiovascular disease and malignant neoplasms have been the leading causes of death in the USA. As treatments for cancer, cardiovascular disease, diabetes and other chronic illnesses improve, we are seeing more complicated patients in our clinics. Cancer therapies such as anthracyclines and radiation therapy continue to pose a risk for delayed-onset cardiovascular disease, in spite of decades of research. It has been reported that the risk of congestive heart failure is the second most common, late, long-term disabling health condition among cancer survivors. Improved understanding of an individual's risk for cardiovascular complications of these therapies and earlier intervention for selected patients may help to improve the overall outcome for patients requiring these therapies. New therapies targeting oncogenes and the process of angiogenesis have 'off-target' effects regarding the cardiovascular system that remain poorly understood. Our knowledge and experience in the cardiovascular care of patients with cancer must continue to grow if we are to assure the best possible outcome for these people. The aim of this review is to highlight the risk of chemotherapy-induced cardiotoxicity among several of the most commonly used cancer therapies, various ways to screen for patients at highest risk of cardiotoxicity and management of cardiac complications of cancer therapy. We spend a disproportionate amount of space and time on the subject of anthracycline toxicity due to its often devastating nature, and its persistence as a clinical problem despite decades of use and research.