Cancer Treatment-Related Ischemic Heart Disease

Advances in cancer therapy have led to a growing number of cancer survivors. However, atherosclerotic cardiovascular disease, particularly ischemic heart disease (IHD), has emerged as a major determinant of the long-term prognosis in this population. Cancer and IHD share not only traditional risk factors, such as aging, hypertension, diabetes, dyslipidemia, obesity, and smoking, but also recently recognized factors, including clonal hematopoiesis of indeterminate potential. Moreover, anticancer treatments, including cytotoxic chemotherapy, molecular-targeted agents, immune checkpoint inhibitors, and radiation therapy, can increase the risk of IHD through endothelial injury, inflammation, hypercoagulability, and microvascular dysfunction. This review summarizes the epidemiology and mechanisms of IHD in patients with cancer, the cardiovascular toxicity profiles associated with each cancer treatment modality, and the risk assessment and revascularization strategies that interventional cardiologists should consider. Finally, we highlighted the importance of comprehensive management by a multidisciplinary cardiology team.