Reimagining Oncologic Drugs in Atherosclerosis: Emerging Mechanisms and Therapeutic Potential

Abstract

Atherosclerosis is a chronic vascular disease that underlies the pathogenesis of both peripheral arterial disease and coronary artery disease, two of the leading causes of morbidity and mortality worldwide. Characterized by the accumulation of lipids, chronic inflammation, and fibrotic remodeling within vasculature, atherosclerosis involves a complex interplay of endothelial dysfunction, immune dysregulation, vascular smooth muscle cell proliferation, and maladaptive neovascularization. Increasing evidence now suggests that atherosclerosis has notable overlap with cancer biology, including sustained proliferative signaling, evasion of immune surveillance, angiogenesis, and resistance to cell death. These shared molecular features have prompted growing interest in the potential repurposing of oncologic treatments in the modulation of atherosclerotic disease. While preclinical data are promising, successful translation and integration of oncologic therapeutics will require overcoming critical barriers, including drug toxicity, long-term safety, regulatory constraints, and cost-effectiveness. Future work should focus on biomarker-guided patient selection, dose optimization, and targeted delivery systems to minimize off-target effects while enhancing efficacy.