Journal: Circulation
This American Heart Association scientific statement reviews how cancer and coronary atherosclerosis intersect and what this means for clinical practice.
Key points:
- Shared risk factors and biology: Traditional factors (smoking, age, obesity, hypertension, diabetes) and emerging ones such as clonal hematopoiesis of indeterminate potential increase risk for both cancer and coronary artery disease. These same factors also heighten susceptibility to cardiotoxicity from cancer treatments.
- Role of inflammation and cancer therapies: Inflammation is central to atherogenesis. Many oncologic therapies—including anthracyclines, 5‑fluorouracil, tyrosine kinase inhibitors, hormone therapies (androgen deprivation, aromatase inhibitors), immune checkpoint inhibitors, and radiation—exacerbate vascular inflammation, endothelial dysfunction, and plaque instability, accelerating coronary disease.
- Imaging for detection and surveillance: The statement synthesizes data on noninvasive imaging (cardiac CT, nuclear imaging, cardiac MRI, echocardiography) for early detection, risk stratification, and longitudinal surveillance of coronary artery disease in patients with cancer. It also reviews invasive imaging to guide revascularization decisions.
- Management around PCI and antiplatelet therapy: Because patients with cancer often have both high bleeding and thrombotic risk, the document emphasizes individualized post‑PCI strategies, including consideration of shortened dual antiplatelet therapy regimens.
- Gaps and future directions: The authors highlight insufficient evidence for optimal risk stratification and management of atherosclerotic cardiovascular disease in oncology populations and call for more research.
- Clinical implication: Given shared pathobiology, the statement advocates an integrated, multidisciplinary approach (cardiology–oncology collaboration) for screening, diagnosis, and management of coronary artery disease in patients with current or prior cancer.