Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association

Abstract

Cardio-oncology has organically developed as a new discipline within cardiovascular medicine as a result of the cardiac and vascular adverse sequelae of the major advances in cancer treatment. Patients with cancer and cancer survivors are at increased risk of vascular disease for a number of reasons. First, many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications. Second, cancer itself serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events. Finally, recent data suggest that common modifiable and genetic risk factors predispose to both malignancies and cardiovascular disease. Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation. Indeed, vascular sequelae of novel targeted therapies may provide insights into vascular signaling in humans. Clinically, emerging challenges are best addressed by a multidisciplinary approach in which cardiovascular medicine specialists and vascular biologists work closely with oncologists in the care of patients with cancer and cancer survivors. This novel approach realizes the goal of providing superior care through the creation of cardio-oncology consultative services and the training of a new generation of cardiovascular specialists with a broad understanding of cancer treatments.

Keywords: AHA Scientific Statements; cardiovascular diseases; medical oncology; therapeutics.

Figure 1. Two-year incidence of venous thromboembolism (VTE) by type and spread of cancer.

Modified from Timp et al with permission of the American Society of Hematology; permission conveyed through Copyright Clearance Center, Inc. Copyright © 2013, American Society of Hematology.

Figure 2. Cardiovascular (CV) complications in the oncology population and comprehensive cardio-oncology services across the cancer treatment continuum.

DVT indicates deep vein thrombosis; HER2, human epidermal growth factor receptor-2; TKI, tyrosine kinase inhibitor; and VSPI, vascular endothelial growth factor signaling pathway inhibitors. Modified from Barac et al with permission from the American College of Cardiology Foundation. Copyright © 2015, American College of Cardiology Foundation.

Figure 3. Integrated multidisciplinary approach and focus on patient care, research (basic, translational, clinical, and population science), education, and clinical training.

CV indicates cardiovascular.