Ischemic heart disease and cardio-onco-hematology: a comprehensive review.

Abstract

Background: Cardiovascular disease and cancer represent the leading causes of mortality worldwide. The coexistence of ischemic heart disease and cancer is increasing due to shared risk factors, improved cancer survival, and cardiovascular toxicity from antineoplastic treatments. This complex relationship poses unique diagnostic and therapeutic challenges requiring multidisciplinary management approaches.

Main body: This comprehensive review examines the multifaceted relationship between ischemic heart disease and cancer, analyzing firstly shared risk factors including smoking, sedentary lifestyle, obesity, diabetes, dyslipidemia and hypertension. We discuss the pathophysiological mechanisms linking cancer and ischemic heart disease, particularly chronic inflammatory states and prothrombotic conditions. The review systematically evaluates cardiovascular toxicity associated with major cancer therapies, including chemotherapy (fluoropyrimidines, platinum compounds, proteasome inhibitors), targeted therapy (vascular endothelial growth factor inhibitors), radiotherapy, immunotherapy, and hormonal treatments. We address the clinical presentation spectrum from asymptomatic ischemia to acute coronary syndromes, highlighting diagnostic challenges and management particularities in cancer patients. Special attention is given to the management of patients with thrombocytopenia and the specific case of fluoropyrimidine-induced cardiotoxicity.

Conclusions: The intersection of ischemic heart disease and cancer requires specialized cardio-oncology expertise to optimize both cancer treatment and cardiovascular outcomes. Early cardiovascular risk stratification, careful selection of cancer therapies, and coordinated multidisciplinary care are essential. As cancer survivorship continues to improve, long-term cardiovascular monitoring and risk factor modification become increasingly important. Future research should focus on developing predictive biomarkers, cardioprotective strategies, and evidence-based guidelines to better manage this complex patient population.