Cardiovascular Considerations Before Cancer Therapy

Baseline cardiovascular assessment before the initiation of potentially cardiotoxic cancer therapies is a key component of cardio-oncology, aiming to reduce cardiovascular complications and morbidity in patients and survivors. Recent clinical practice guidelines provide both general and cancer thera...

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Published in:JACC CardioOncology 2024-10, Vol.6 (5), p.631-654
Main Authors: Raisi-Estabragh, Zahra, Murphy, Alexandra C., Ramalingam, Sivatharshini, Scherrer-Crosbie, Marielle, Lopez-Fernandez, Teresa, Reynolds, Kerry L., Aznar, Marianne, Lin, Amy E., Libby, Peter, Cordoba, Raul, Bredsen-Masley, Christine, Wechalekar, Ashu, Apperley, Jane, Cheng, Richard K., Manisty, Charlotte H.
Format: Article
Language:English
Subjects:
5-Fluorouracil
Anthracycline
Biomarkers
Cardio-Oncology
Cardiotoxicity
Echocardiography
Guidelines
Heart Failure
Her2 Therapy
Scientific Statements
Tyrosine Kinase Inhibitor
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Summary:Baseline cardiovascular assessment before the initiation of potentially cardiotoxic cancer therapies is a key component of cardio-oncology, aiming to reduce cardiovascular complications and morbidity in patients and survivors. Recent clinical practice guidelines provide both general and cancer therapy–specific recommendations for baseline cardiovascular toxicity risk assessment and management, including the use of dedicated risk scores, cardiovascular imaging, and biomarker testing. However, the value of such interventions in altering disease trajectories has not been established, with many recommendations based on expert opinion or Level of Evidence: C, studies with a potential for high risk of bias. Advances in understanding underlying mechanisms of cardiotoxicity and the increased availability of genetic and immunologic profiling present new opportunities for personalized risk assessment. This paper evaluates the existing evidence on cardiovascular care of cancer patients before cardiotoxic cancer therapy and highlights gaps in evidence and priorities for future research. [Display omitted] •Risk stratification and cardiovascular optimization are recommended for all patients before undergoing cardiotoxic cancer therapies.•Current guidelines are supported by Level of Evidence: C across many clinical scenarios, and greater evidence is needed to inform future cardio-oncology guidelines.•Although cardiovascular imaging and biomarkers may facilitate risk stratification, their prognostic value is unclear.•Developing validated risk scores and novel biomarkers is a critical research priority aimed at achieving personalized assessments of cardiotoxicity.
ISSN:2666-0873
2666-0873
DOI:10.1016/j.jaccao.2024.07.017