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Ischemic heart disease and cardio-onco-hematology: a comprehensive review
Santiago Jiménez-Marrero1,2,3, Herminio Morillas1,2, Alexandra Pons-Riverola1,2
1Department of Cardiology, Hospital Universitari de Bellvitge, 19th Floor. Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
Insights
Managing patients with both cancer and ischemic heart disease requires specialized cardio-oncology care. Early risk assessment and tailored treatments are crucial for optimizing outcomes in this complex population.
Area of Science:
- Cardio-Oncology
- Oncology
- Cardiology
Background:
- Cardiovascular disease and cancer are leading global causes of death.
- Their coexistence is rising due to shared risk factors, better cancer survival, and treatment toxicity.
- This complex interplay presents diagnostic and therapeutic challenges.
Purpose of the Study:
- To review the relationship between ischemic heart disease and cancer.
- To analyze shared risk factors and pathophysiological links.
- To evaluate cardiovascular toxicity of cancer therapies and management strategies.
Main Methods:
- Comprehensive literature review.
- Analysis of shared risk factors (smoking, obesity, diabetes, etc.).
- Systematic evaluation of cardiotoxicity from chemotherapy, targeted therapy, radiotherapy, immunotherapy, and hormonal treatments.
Main Results:
- Shared risk factors like inflammation and prothrombotic states link both diseases.
- Cancer therapies pose significant cardiovascular risks, varying by treatment type.
- Management requires addressing diagnostic challenges, thrombocytopenia, and specific toxicities like fluoropyrimidine-induced cardiotoxicity.
Conclusions:
- Specialized cardio-oncology expertise is vital for managing patients with cancer and ischemic heart disease.
- Early risk stratification, careful therapy selection, and multidisciplinary care are essential.
- Long-term monitoring and risk factor modification are key as cancer survivorship improves.
Background:
Cardiovascular disease and cancer represent the leading causes of mortality worldwide. The coexistence of ischemic heart disease and cancer is increasing due to shared risk factors, improved cancer survival, and cardiovascular toxicity from antineoplastic treatments. This complex relationship poses unique diagnostic and therapeutic challenges requiring multidisciplinary management approaches.
Main Body:
This comprehensive review examines the multifaceted relationship between ischemic heart disease and cancer, analyzing firstly shared risk factors including smoking, sedentary lifestyle, obesity, diabetes, dyslipidemia and hypertension. We discuss the pathophysiological mechanisms linking cancer and ischemic heart disease, particularly chronic inflammatory states and prothrombotic conditions. The review systematically evaluates cardiovascular toxicity associated with major cancer therapies, including chemotherapy (fluoropyrimidines, platinum compounds, proteasome inhibitors), targeted therapy (vascular endothelial growth factor inhibitors), radiotherapy, immunotherapy, and hormonal treatments. We address the clinical presentation spectrum from asymptomatic ischemia to acute coronary syndromes, highlighting diagnostic challenges and management particularities in cancer patients. Special attention is given to the management of patients with thrombocytopenia and the specific case of fluoropyrimidine-induced cardiotoxicity.
Conclusions:
The intersection of ischemic heart disease and cancer requires specialized cardio-oncology expertise to optimize both cancer treatment and cardiovascular outcomes. Early cardiovascular risk stratification, careful selection of cancer therapies, and coordinated multidisciplinary care are essential. As cancer survivorship continues to improve, long-term cardiovascular monitoring and risk factor modification become increasingly important. Future research should focus on developing predictive biomarkers, cardioprotective strategies, and evidence-based guidelines to better manage this complex patient population.
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