Abstract
Preventive Cardio-Oncology: The Time Has Come.
Highlights
The time has come for cardiovascular disease (CVD) prevention to play a more prominent role in cardio-oncology (Figure 1A)
In addition to the CVD risk scores used in the general population, such as the American Heart Association (AHA) and American College of Cardiology (ACC) pooled cohort atherosclerotic cardiovascular disease risk equations, there are scores being developed for assessing CVD risk in individuals with a history of adult or childhood cancer [49, 50]
Will it be too late to wait? Should we primarily focus our efforts on rehabilitation after cancer therapies, or should we turn our attention to habilitation during cancer therapies while patients are undergoing cycles of chemotherapy and radiation before or after surgery? should we start sooner? Should we advocate for initiating cardio-oncology prehabilitation before patients undergo chemotherapy, radiation, or surgery? In the overall surgical world, exercise or nutritional prehabilitation seems to improve outcomes and lower healthcare costs compared to waiting for rehabilitation alone [124,125,126,127,128,129,130,131,132,133,134,135,136,137]
Summary
The time has come for cardiovascular disease (CVD) prevention to play a more prominent role in cardio-oncology (Figure 1A). Systemic hypertension occurs in more than one fourth of all individuals treated with vascular endothelial growth factor inhibitors (small molecule tyrosine kinase inhibitors), while all patients experience some increase in their blood pressure [24] These drugs associate with cardiomyopathy, vasculopathy, coagulopathy, and nephropathy largely due to systemic endothelial dysfunction, reduced nitric oxide production, and destruction of the glomerular filtration barrier resulting from alteration of the balance between angiogenic and antiangiogenic, or vasoconstrictor and vasodilator, factors [24,25,26]. CAD, coronary artery disease; CHF, congestive heart failure; CV, cardiovascular; CVD, cardiovascular disease; Echo, echocardiogram; ECG, electrocardiogram; Gy, Gray; ICIs, immune checkpoint inhibitors; PAD, peripheral artery disease; RT, radiation therapy; TIA, transient ischemic attack; VEGFI, vascular endothelial growth factor inhibitor (a tyrosine kinase inhibitor)
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