Cardio-Oncology Cardiovascular toxicity and antineoplastics

Abstract

The last century has witnessed record-high life expectancy, mainly related to decreasing infectious disease as the cause of mortality, paralleded with this tendency there has been a shift in mortality towards non-infectious causes, mainly cardiovascular disease and cancer. With new antineoplastic therapies there is now a large number of long term cancer survival population. It is now known that specific cancer therapies increase the risk of cardiovascular disease, and in the last 20 or 30 years, we have observed an increased prevalence of heart failure, ischemic heart disease, arrhythmias, and hypertension in cancer patients survivors. In this article, we review general aspects related to antineoplastic therapy, including action mechanism of most common used anti-cancer agents, also, issues over tyrosine-kinase inhibitors nomenclature, and classification of cardiotoxicity. The variety of anti-cancer agents is increasing every day, and we will briefly summarize the description of different antineoplastic drugs, including traditional and new targeted and immune-oncological therapeutic agents and how they relate to cardiovascular toxicity. Classic clinical cardiovascular risk factors are known predictors of potential cardiotoxicity, and together with cardiac biomarkers and imaging techniques facilitate the early diagnosis of cardiotoxicity in the subclinical/asymptomatic stage that permits implement preventive measures. There have also been therapeutic advances in the symptomatic stage that will be disclosed. This area is in continuous evolution, and it is convenient to involve the general cardiologist mind in this relatively new topic, understanding that in not all the world there are specialized cardio-oncology units, but equally, as cardiologist, we have to collaborate with the oncologist in the treatment of patients with cancer.