Tumours and the heart: common risk factors, chemotherapy, and radiation

Tumours and heart disease remain the most important causes of morbidity and mortality worldwide. Interestingly, in some countries—thanks to the enormous progress made in cardiology over the last decades—cancer has surpassed heart disease as the major cause of mortality.1 However, oncology has also seen an impressive expansion of its therapeutic options with the development of more effective chemotherapeutic drugs. Unfortunately, some chemotherapeutics, in particular anthracyclins, actually have toxic cardiovascular effects. Most commonly, they interfere with the myocardium, reduce cardiac pump function, and eventually induce heart failure, cause arrhythmias, or promote coronary lesion formation. As a result, many heart centres have established specialized units in cardio-oncology in order to improve the management of such patients. Thus, the Position Paper on Cardio-Oncology entitled ‘2016 ESC Position Paper on cancer treatments and cardiovascular toxicity’ by Zamorano et al. on behalf of the ESC Committee for Practice Guidelines and the Task Force for Cancer Treatments and Cardiovascular Toxicity of the European Society of Cardiology is a timely document.2 The authors review the different agents, the pathophysiology of their different toxic effects on the cardiovascular system such as myocardial toxicity, among others, and the diagnostic and potentially preventive and therapeutic options that are avialable. Unfortunately, many attempts to prevent or reverse chemotherapy-induced myocardial dysfunction have failed, such as the recent PRADA trial with candesartan and metoprolol.3 Thus, it appears that currently cancer drug-associated heart failure remains a substantial health problem, and a better understanding of the pathophysiology of cardiotoxicity may lead to the design of specific, targeted drug therapies.4 In addition, large trials with long follow-up are required to identify potentially beneficial treatment strategies for these patients.