From the Guidelines
Chemotherapy can contribute to the development of coronary artery disease (CAD) in some patients, particularly with certain agents and at higher cumulative doses. The risk of CAD development is associated with anthracyclines, alkylating agents, and some targeted therapies, such as trastuzumab, as reported in a study published in the Journal of the American College of Cardiology 1. According to this study, the anthracycline class of chemotherapy drugs is known to cause cardiotoxicity in a dose-dependent manner.
Key Factors Contributing to CAD Risk
- Higher cumulative doses of certain chemotherapy agents, such as doxorubicin exceeding 400 mg/m²
- Pre-existing cardiovascular disease
- Older age
- Hypertension
- Diabetes
- Smoking
- Prior chest radiation
Mechanisms of Chemotherapy-Induced CAD
- Direct cardiac cell toxicity
- Oxidative stress
- Inflammation
- Endothelial dysfunction These effects can accelerate atherosclerosis, impair cardiac function, and increase CAD risk, as discussed in a study published in the same journal 1.
Recommendations for Patients Undergoing Chemotherapy
- Cardiovascular risk assessment before treatment
- Regular monitoring during therapy
- Long-term follow-up after completion
- Cardioprotective strategies, such as dexrazoxane administration with anthracyclines, liposomal formulations of doxorubicin, or preventive medications like ACE inhibitors or beta-blockers in high-risk patients, as suggested in another study 1.
It is essential to carefully evaluate and manage cardiovascular risk factors in patients undergoing chemotherapy to minimize the risk of CAD development and other cardiovascular complications.
From the Research
Chemotherapy and Coronary Artery Disease (CAD)
- Chemotherapy has been associated with an increased risk of coronary artery disease (CAD) in various studies 2, 3.
- A study published in 2020 found that chemotherapy is associated with anatomical complexity and severity of CAD, which might partly account for the higher risk of chemotherapy-related CAD among lung cancer patients 2.
- Another study published in 2024 discussed the mechanisms and management of chemotherapy-mediated coronary damage, including acute vasospasm, acute thrombosis, accelerated atherosclerosis development, and microvascular dysfunction 3.
Mechanisms of Chemotherapy-Related CAD
- The underlying mechanism of chemotherapy-related CAD remains unclear, but studies suggest that it may be related to the type of chemotherapy and the type of cancer being treated 2, 3.
- Anthracycline chemotherapy has been shown to cause cardiac toxicity, including reduced left ventricular ejection fraction and global longitudinal strain 4.
- Statin use has been associated with decreased risk of cardiotoxicity after anthracycline and/or trastuzumab exposure 5.
Management of CAD in Cancer Patients
- Patients with cancer who develop CAD are less likely to receive timely revascularization or appropriate medical therapy, despite evidence showing that receipt of these interventions is associated with substantial benefit 6.
- A multidisciplinary approach is recommended to guide treatment decisions in this high-risk and growing patient group 6.
- The risk-benefit balance of revascularization is becoming more favorable due to the improving prognosis of many cancers and safer revascularization strategies 6.