[Hematologic malignancies and increased cardiovascular risk: a new issue to be considered for patient follow-up]

The last decade has seen a significant increase in the number of long survivors after a hematologic cancer, both children and adults, due to significant improvement in treatment. This exciting result, however, has been associated with an increase in the occurrence of previously unknown cardiovascular complications, including acute myocardial infarction, stroke, heart failure, deep vein thrombosis and pulmonary embolism. These adverse outcomes are due to both the hematologic cancer per se and to antineoplastic therapy. Cancer-dependent complications are caused by a shift of blood and endothelial cells to a prothrombotic and proinflammatory phenotype associated also with cancer-related somatic gene mutations. Antineoplastic therapy, instead, can lead to adverse outcomes due to an increase in oxidative stress resulting from the effects of reactive oxygen and nitrogen species which can induce alterations of mitochondria and other intracellular organelles. In addition, cardiovascular complications following a hematologic malignancy are also due to the interaction between cancer and traditional cardiovascular risk factors such as smoking, hypertension, obesity and diabetes. Clinicians should take all of these factors into account, and adapt their usual follow-up schemes accordingly in patients who have survived a hematologic cancer.