Advancing cardio-oncology: precision-guided cardiovascular care for oncology patients

Cardio-oncology, an emerging subspecialty at the intersection of cardiology and oncology, addresses the growing cardiovascular burden among cancer patients and survivors. Advances in cancer therapies, including anthracyclines, immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell therapy, and targeted tyrosine kinase inhibitors (TKIs), have improved survival but also introduced diverse cardiovascular complications such as heart failure, arrhythmias, hypertension, and ischemia. These complications are influenced by traditional cardiovascular risk factors, aging, and comorbidities, underscoring the need for precision-guided risk assessment and management. Recent innovations in cardio-oncology focus on personalized risk stratification using clinical risk models, genetic profiling, and emerging biomarkers such as high-sensitivity troponin, natriuretic peptides, and microRNAs. Advanced imaging modalities, including echocardiography, global longitudinal strain analysis, and cardiac magnetic resonance, are central to early detection of subclinical injury, with artificial intelligence (AI) increasingly enabling real-time, individualized surveillance. The integration of novel biological insights, such as clonal hematopoiesis of indeterminate potential, further refines risk prediction and mechanistic understanding. Effective cardio-oncology care requires proactive, multidisciplinary strategies that span the continuum from treatment initiation to survivorship, emphasizing longitudinal monitoring, cardioprotective interventions, and patient-centered care. Despite progress, challenges remain in standardizing predictive models, validating biomarkers, and ensuring equitable access to specialized services. Looking forward, the convergence of AI-driven imaging, multi-omic data, and precision therapeutics promises to transform cardio-oncology from reactive management to proactive, personalized care, optimizing both cancer outcomes and long-term cardiovascular health.