Abstract
Assessment of endothelial dysfunction in cancer survivors may have a role in the early identification of non-communicable diseases and cardiovascular late effects. Oncological therapies may impair endothelial function. Therefore, in patients such as childhood cancer survivors who could benefit from early cardioprotective pharmacological interventions, it is essential to monitor endothelial function, even if the optimal methodology for investigating the multifaceted aspects of endothelial dysfunction is still under debate. Biochemical markers, as well as invasive and non-invasive tools with and without pharmacological stimuli have been studied. Human clinical studies that have examined lifestyle or cancer treatment protocols have yielded evidence showing the involvement of lipid and lipoprotein levels, glycemic control, blood pressure, adiposity, inflammation, and oxidative stress markers on the state of endothelial health and its role as an early indicator of cardiometabolic risk. However, with regards to pharmacological interventions, cautious interpretation of the result attained whilst monitoring the endothelial function is warranted due to methodological limitations and substantial heterogeneity of the results reported in the published studies. In this narrative review, an overview of evidence from human clinical trials examining the effects of cancer therapies on endothelial disease is provided together with a discussion of endothelial function assessment using the different non-invasive techniques available for researchers and clinicians, in recent years.
Highlights
This review provides a detailed description of the methodology, limitations, and current pediatric experiences, in recent years, associated with the most used non-invasive methods to evaluate the endothelial function
The need for screening, treatment, and prevention of vascular toxic effects of anticancer therapies is supported by consolidated data
The gold standard method continues to be the endothelial vasomotor testing performed with intracoronary administration of vasoactive reagents such as acetylcholine
Summary
Cancer and cardiovascular diseases are the most common causes of non-communicable diseases [1] and premature death in Western countries [2]. In recent years, improved survival rates in childhood cancer patients have increased the overall population of survivors. The population of survivors is increasing over time, and with it has come greater recognition of the importance of the adverse effects of cancer therapies, the need for a better understanding of the etiopathogenetic mechanisms underlying cardiovascular damage after cancer therapies, and an improved ability to detect its first signs. CCS are significantly more likely to take medications for hypertension (odds ratio (OR), 1.9), dyslipidemia (OR, 1.6), or diabetes (OR, 1.7) than their sibling controls [4], and the risk of cardiovascular disease with premature mortality rate is 5–10 times more common [5]. While clinical monitoring for cardiotoxicities has been described in numerous articles and validated by guidelines, only a few reports evaluating potential clinical strategies for monitoring vascular toxicity during and following anticancer treatment exist, reflecting a serious gap in our current knowledge and the need to identify potential non-invasive methods to assess vascular toxicity [7]
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