Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 30;17(7):1169.
doi: 10.3390/cancers17071169.

In the Era of Cardiovascular-Kidney-Metabolic Syndrome in Cardio-Oncology: From Pathogenesis to Prevention and Therapy

Vincenzo Quagliariello  1 , Massimiliano Berretta  2 , Irma Bisceglia  3 , Ilaria Giacobbe  1 , Martina Iovine  1 , Matteo Barbato  1 , Carlo Maurea  4 , Maria Laura Canale  5 , Andrea Paccone  1 , Alessandro Inno  6 , Marino Scherillo  7 , Stefano Oliva  8 , Christian Cadeddu Dessalvi  9 , Alfredo Mauriello  1 , Celeste Fonderico  1 , Anna Chiara Maratea  1 , Domenico Gabrielli  10 , Nicola Maurea  1
Affiliations
Review

In the Era of Cardiovascular-Kidney-Metabolic Syndrome in Cardio-Oncology: From Pathogenesis to Prevention and Therapy

Vincenzo Quagliariello et al. Cancers (Basel). .

Abstract

Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interplay between cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders, significantly impacting cancer patients. The presence of CKM syndrome in cancer patients not only worsens their prognosis but also increases the risk of major adverse cardiovascular events (MACE), reduces quality of life (QoL), and affects overall survival (OS). Furthermore, several anticancer therapies, including anthracyclines, tyrosine kinase inhibitors, immune checkpoint inhibitors, and hormonal treatments, can exacerbate CKM syndrome by inducing cardiotoxicity, nephrotoxicity, and metabolic dysregulation. This review explores the pathophysiology of CKM syndrome in cancer patients and highlights emerging therapeutic strategies to mitigate its impact. We discuss the role of novel pharmacological interventions, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and soluble guanylate cyclase (sGC) activators, as well as dietary and lifestyle interventions. Optimizing the management of CKM syndrome in cancer patients is crucial to improving OS, enhancing QoL, and reducing MACE. By integrating cardiometabolic therapies into oncologic care, we can create a more comprehensive treatment approach that reduces the burden of cardiovascular and renal complications in this vulnerable population. Further research is needed to establish personalized strategies for CKM syndrome prevention and treatment in cancer patients.

Keywords: PCSK9; cancer; cardio-oncology; cardiotoxicity; kidney diseases; metabolic syndrome; metabolism; obesity.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overall description of CV risk, kidney and metabolic dysfunction, cancer-related toxicity, survival, inflammation, and therapeutic challenges during CKM.
Figure 2
Figure 2
Schematic description of CKM progression in cancer patients (from stage 0 to stage 4) and impact of anticancer therapies.
See this image and copyright information in PMC

References

    1. Moslehi J.J. Cardio-Oncology: A New Clinical Frontier and Novel Platform for Cardiovascular Investigation. Circulation. 2024;150:513–515. doi: 10.1161/CIRCULATIONAHA.124.065473. - DOI - PMC - PubMed
    1. Kostakou P.M., Kouris N.T., Kostopoulos V.S., Damaskos D.S., Olympios C.D. Cardio-oncology: A new and developing sector of research and therapy in the field of cardiology. Heart Fail. Rev. 2019;24:91–100. doi: 10.1007/s10741-018-9731-y. - DOI - PubMed
    1. Sebastian S.A., Padda I., Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review. Curr. Probl. Cardiol. 2024;49:102344. doi: 10.1016/j.cpcardiol.2023.102344. - DOI - PubMed
    1. Ferdinand K.C. An overview of cardiovascular-kidney-metabolic syndrome. Am. J. Manag. Care. 2024;30((Suppl. S10)):S181–S188. doi: 10.37765/ajmc.2024.89670. - DOI - PubMed
    1. Claudel S.E., Verma A. Cardiovascular-kidney-metabolic syndrome: A step toward multidisciplinary and inclusive care. Cell Metab. 2023;35:2104–2106. doi: 10.1016/j.cmet.2023.10.015. - DOI - PMC - PubMed

LinkOut - more resources