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Cardiovascular disease and malignancy are the leading causes of death for approximately two-thirds of the population in developed countries. Over the last five decades, both these clinical fields have observed major breakthroughs in various diseases, such as reperfusion for acute myocardial infarction and targeted molecular cancer therapies, leading to improved survivorship and significant reductions in disease-related morbidity. One area of intense focus for both fields has been the development of novel biomarkers for diagnosis, disease surveillance, targeting therapies with companion diagnostics, monitoring response to treatment and prognosis. The application of increasingly more varied, sensitive and sophisticated biomarkers has contributed to the major gains in healthcare outcomes for patients diagnosed with cardiovascular disease or cancer.
The adverse impact of some cancer therapies on the cardiovascular system has been known for several decades, such as anthracycline-induced and radiation-induced cardiotoxicity. This problem has escalated in recent years with the growing number of targeted molecular therapies, which has significant efficacy on specific cancers, but increasingly more complex cardiovascular toxicity profiles impacting on the outcomes in the cancer survivors. This has resulted in the rapid growth of ‘cardio-oncology’ as a new medical subspecialty to concentrate knowledge, understanding, education and care of the cardiovascular comorbidities, risks and complications in patients with cancer as they progress through their treatment pathways with potential cardiotoxicity.
A new challenge has arisen relating to the potential impact of the cancer itself on cardiovascular health. It has been recognised for many years that inflammation and various inflammatory cytokine profiles are elevated in cancer, and contribute to cancer disease progression.1 In parallel, similar and overlapping pathways such as interleukin 1 (IL-1), IL-6 and tumour necrosis factor α are also activated in chronic cardiovascular diseases such as atherosclerosis and heart failure, where again they contribute to disease progression.2 In both cancer and …
Competing interests Research contracts, consultancy work and advisory boards for Pfizer, Onyx pharmaceuticals, Ferring Pharmaceuticals and Clinigen Group in the field of cardio-oncology.
Provenance and peer review Commissioned; internally peer reviewed.