Breast cancer and cardiovascular health

• Published in: European heart journal 2024-11, Vol.45 (41), p.4366-4382
• Main Authors: López-Fernández, Teresa, Marco, Irene, Aznar, Marianne C, Barac, Ana, Bergler-Klein, Jutta, Meattini, Icro, Scott, Jessica M, Cardinale, Daniela, Dent, Susan
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - adverse effects; Breast Neoplasms - therapy; Cardiotoxicity - etiology; Cardiotoxicity - prevention & control; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Female; Humans; Risk Factors
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehae637

Abstract Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer. Graphical Abstract Graphical Abstract Improved survival rates and the increasing complexity of modern cancer treatments require a comprehensive understanding of the risk factors and underlying pathophysiological mechanisms that contribute to cardiovascular toxicity. The oncologist is usually responsible for baseline risk assessment and the cardiologist for monitoring cardiovascular risks and managing cardiotoxicity. However, for optimal outcomes in breast cancer patients, all cardiologists must understand the cardiovascular implications of cancer therapy and emphasize collaboration with the oncology team during and after cancer treatment. A multidisciplinary approach, particularly in patients with pre-existing cardiovascular risk factors and/or cardiovascular disease, is needed to ensure adherence to optimal cardiovascular therapy and to minimize the risk of interruptions in breast cancer treatment.