Radiotherapy, chemotherapy and atherosclerosis

This article reviews the effects of radiotherapy and chemotherapy in promoting the progression of atherosclerosis in patients with cancer.

Radiotherapy is associated with an increase in the incidence of atherosclerosis with the effects being related to the site of irradiation and dose of radiotherapy. Cranial irradiation is associated with dyslipidaemia and the metabolic syndrome secondary to effect on growth hormone secretion. Chemotherapeutic oncological therapies are associated with numerous cardiac diseases including valve disease, pericarditis and cardiomyopathy but can also promote atherosclerosis. Therapies directed against vascular endothelial growth factor including tyrosine kinase inhibitors have a direct effect in raising blood pressure and increase rates of cardiovascular disease (CVD) events. Antimetabolites such as 5-fluorouraciland capecitabine cause chest pain and increase CVD events. Anthracyclines cause heart failure and may increase CVD risk.

There is increasing evidence that radiotherapy and some chemotherapeutic agents are associated with increased rates of CVD. Patients who have received treatment for cancer should be considered at higher risk of developing atherosclerosis and require increased monitoring, further investigation and earlier treatment than would be suggested by classical risk factor management strategies.