Baseline blood pressure and development of cardiotoxicity in patients treated with anthracyclines: A systematic review

Investigation of chemotherapy-induced cardiac dysfunction in breast cancer

Although recent advancements in cancer treatment have significantly improved survival rates, they have also raised concerns regarding severe adverse effects, including cardiotoxicity. We conducted a prospective study at Dayanand Medical College and Hospital, Ludhiana to assess chemotherapy-related cardiac dysfunction in newly diagnosed, histologically confirmed breast cancer cases. Among 97 breast cancer patients undergoing chemotherapy, 13 (13.4%) developed left ventricular dysfunction (LVD), predominantly in younger patients with left-sided breast involvement (64.9%). A significant association was found between estrogen receptor (ER) positivity and LVD risk (P = 0.03), with 15.4% of LVD patients also being hypertensive. The incidence of LVD was notably high at 38.5% among patients receiving trastuzumab, while cumulative doses of doxorubicin and cyclophosphamide did not show significant correlation with LVD. Recovery was promising, with 76.9% of affected patients demonstrating significant improvement post-treatment. These findings highlight the need for continuous cardiac monitoring and personalized treatment strategies to mitigate LVD risk.

Cardiovascular Considerations Before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations

Baseline cardiovascular assessment before the initiation of potentially cardiotoxic cancer therapies is a key component of cardio-oncology, aiming to reduce cardiovascular complications and morbidity in patients and survivors. Recent clinical practice guidelines provide both general and cancer therapy-specific recommendations for baseline cardiovascular toxicity risk assessment and management, including the use of dedicated risk scores, cardiovascular imaging, and biomarker testing. However, the value of such interventions in altering disease trajectories has not been established, with many recommendations based on expert opinion or Level of Evidence: C, studies with a potential for high risk of bias. Advances in understanding underlying mechanisms of cardiotoxicity and the increased availability of genetic and immunologic profiling present new opportunities for personalized risk assessment. This paper evaluates the existing evidence on cardiovascular care of cancer patients before cardiotoxic cancer therapy and highlights gaps in evidence and priorities for future research.

Doxorubicin-induced cardiotoxicity and risk factors

Doxorubicin (DOX) is an anthracycline antibiotic widely used as a chemotherapeutic agent to treat solid tumours and hematologic malignancies. Although useful in the treatment of cancers, the benefit of DOX is limited due to its cardiotoxic effect that is observed in a large number of patients. In the literature, there is evidence that the presence of various factors may increase the risk of developing DOX-induced cardiotoxicity. A better understanding of the role of these different factors in DOX-induced cardiotoxicity may facilitate the choice of the therapeutic approach in cancer patients suffering from various cardiovascular risk factors. In this review, we therefore discuss the latest findings in both preclinical and clinical research suggesting a link between DOX-induced cardiotoxicity and various risk factors including sex, age, ethnicity, diabetes, dyslipidaemia, obesity, hypertension, cardiovascular disease and co-medications.