Coronary artery disease and cancer: Shared risk factors, pathogenesis, and treatment effects

As cancer survival improves, cardiovascular health has become an increasingly important concern, particularly given the elevated risk of coronary artery disease (CAD) in patients with cancer. This review examines the complex relationship between cancer and CAD, focusing on shared epidemiological trends, overlapping risk factors, converging pathophysiological mechanisms, and cancer treatment-related cardiovascular toxicities. Cancer and CAD share modifiable risk factors, including obesity, diabetes, hypertension, hyperlipidemia, smoking, alcohol use, physical inactivity, and poor diet, that may act synergistically to promote both conditions. In addition, biological processes such as chronic inflammation, oxidative stress, platelet activation, and clonal hematopoiesis of indeterminate potential further contribute to disease progression. Several cancer therapies, including antimetabolites, platinum-based agents, immune checkpoint inhibitors, tyrosine kinase inhibitors, and radiotherapy, have been implicated in vascular injury, plaque destabilization, and accelerated atherosclerosis, increasing the risk of CAD. Understanding these shared mechanisms is essential for reducing cardiovascular complications in patients with cancer. This review outlines the epidemiology, risk factors, and biological mechanisms linking CAD and cancer, and evaluates the cardiotoxic effects of commonly used cancer therapies.