A new classification of cardio-oncology syndromes

Abstract

Increasing evidence suggests a multifaceted relationship exists between cancer and cardiovascular disease (CVD). Here, we introduce a 5-tier classification system to categorize cardio-oncology syndromes (COS) that represent the aspects of the relationship between cancer and CVD. COS Type I is characterized by mechanisms whereby the abrupt onset or progression of cancer can lead to cardiovascular dysfunction. COS Type II includes the mechanisms by which cancer therapies can result in acute or chronic CVD. COS Type III is characterized by the pro-oncogenic environment created by the release of cardiokines and high oxidative stress in patients with cardiovascular dysfunction. COS Type IV is comprised of CVD therapies and diagnostic procedures which have been associated with promoting or unmasking cancer. COS Type V is characterized by factors causing systemic and genetic predisposition to both CVD and cancer. The development of this framework may allow for an increased facilitation of cancer care while optimizing cardiovascular health through focused treatment targeting the COS type.

Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology

“…Such complex dual and triple antithrombotic drug combinations increase the risk of GI bleeding substantially [ 165 , 166 ]. Remarkably, the presence of comorbidities amplifies the risk of GI bleeding when these agents are used, with HF being an independent risk factor [ 162 , 167 , 168 , 169 ]. This might suggest that HF patients have a vulnerable gastric mucosa, and using such medications to treat another comorbidity in HF makes them more susceptible to GI lesions.…”

Lifestyle and Cardiovascular Risk Factors Associated With Heart Failure Subtypes in Postmenopausal Breast Cancer Survivors

“…Additionally, shared risk factors may predispose to MI, cancer, and HFpEF. 38 A history of diabetes was significantly associated with HFpEF, and a history of hypertension was of borderline significance, although these relationships did not persist after adjustment for multiple variables. In the general population, diabetes and hypertension have been associated with the risk of both HFrEF and HFpEF and have been linked to pathophysiologic changes associated with HFrEF and HFpEF.…”

Cardiac Cachexia: Unaddressed Aspect in Cancer Patients

“…In addition to the signs and symptoms developed by the tumor-host interactions mediated by the tumor-derived factors, chemotherapies might have detrimental effects on the cardiovascular system, which makes patient management quite challenging since this may further increase the risk of cachexia and deteriorate the existing condition rather than providing relief to cancer patients. Some of cardiotoxic chemotherapies include anthracycline (doxorubicin, daunorubicin), human epidermal growth factor receptor 2 inhibitors (HER-2) (trastuzumab, pertuzumab), alkylating agents (cyclophosphamide, busulfan), taxane (paclitaxel), platinum-based therapies (carboplatin, cisplatin), fluoropyrimidine (5-fluorouracil), tyrosine kinase inhibitors (imatinib) VEGF inhibitors (bevacizumab), immune check point inhibitors (pembrolizumab), and proteasome inhibitors (bortezomib) [84].…”