Reciprocal Mechanisms Linking Cancer and Cardiovascular Disease: Emerging Paradigms in Onco-Cardiology

Area of Science:

• Cardiovascular Medicine
• Oncology
• Molecular Biology

Background:

• Cancer and Cardiovascular Disease (CVD) share risk factors like hypertension, diabetes, and obesity, alongside overlapping molecular pathways including inflammation, oxidative stress, and endothelial dysfunction.
• Shared signaling pathways (NF-κB, JAK/STAT) and pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) link atherogenesis with tumor growth and immune evasion.
• Clonal hematopoiesis and exosomal microRNAs contribute to the bidirectional relationship between CVD and cancer, impacting vascular health and cardiac function.

Purpose of the Study:

• To elucidate the common molecular mechanisms driving the interaction between CVD and cancer.
• To review diagnostic, imaging, and therapeutic strategies for early detection and effective cardioprotection in cancer patients.
• To ensure anticancer treatments do not compromise cardiovascular health.

Main Methods:

• A narrative literature review was conducted.
• Systematic searches were performed on PubMed (MEDLINE), Web of Science, and ScienceDirect.
• Keywords included shared molecular mechanisms, clinical interactions, therapeutic approaches, cardiovascular disease, and cancer, with a search period from January 2010 to December 2025.

Main Results:

• Cancer therapies, including anthracyclines, trastuzumab, VEGF-pathway blockers, and immune checkpoint inhibitors, pose significant cardiovascular risks.
• Epidemiological data confirm a bidirectional relationship: cancer survivors have increased CVD risk, and heart failure patients have increased cancer risk.
• Multimodality imaging (echocardiography, cardiac MRI, PET) and biomarker panels (troponins, natriuretic peptides, cytokines, miRNAs) aid in detecting subclinical injury and guiding cardioprotection.

Conclusions:

• Inflammation, metabolic dysregulation, and thrombosis are key intersections between CVD and cancer.
• Targeting these shared pathways, alongside biomarker-based surveillance and integrated oncology-cardiology care, is crucial.
• These integrated approaches promise earlier diagnosis, reduced treatment toxicity, and improved long-term outcomes for patients with co-existing CVD and cancer.