Cardiovascular diseases are largely represented in patients with cancer and appear to be important side effects of cancer treatments, heavily affecting quality of life and leading to premature morbidity and death among cancer survivors. In particular, treatments for breast cancer have been shown to potentially play serious detrimental effects on cardiovascular health. This review aims to explore the available literature on breast cancer therapy-induced side effects on heart and vessels, illustrating the molecular mechanisms of cardiotoxicity known so far. Moreover, principles of cardiovascular risk assessment and management of cardiotoxicity in clinical practice will also be elucidated. Chemotherapy (anthracycline, taxanes, cyclophosphamide and 5-fluorouracil), hormonal therapy (estrogen receptor modulator and gonadotropin or luteinizing releasing hormone agonists) and targeted therapy (epidermal growth factor receptor 2 and Cyclin-dependent kinases 4 and 6 inhibitors) adverse events include arterial and pulmonary hypertension, supraventricular and ventricular arrhythmias, systolic and diastolic cardiac dysfunction and coronary artery diseases due to different and still not well-dissected molecular pathways. Therefore, cardiovascular prevention programs and treatment of cardiotoxicity appear to be crucial to improve morbidity and mortality of cancer survivors.

Chemotherapies have changed the prognosis of patients affected by cancer over the last 20 years, with a significant increase in survival rates. However, they can cause serious adverse effects that may limit their use. In particular, anthracyclines, widely used to treat both hematologic cancers and solid cancers, may cause cardiac toxicity, leading to the development of heart failure in some cases. This review aims to explore current evidence with regards to anthracyclines’ cardiotoxicity, with particular focus on the classifications and underlying molecular mechanisms, in order to provide an overview on the current methods of its diagnosis, treatment, and prevention. An attentive approach and a prompt management of patients undergoing treatment with anthracyclines is imperative to avoid preventable antineoplastic drug discontinuation and is conducive to improving both short-term and long-term cardiovascular morbidity and mortality.

Aims Cardiovascular (CV) toxicities related to chemotherapy have been reported with increasing frequency. Thus, latest cardio-oncology guidelines focused on the importance of a baseline CV risk assessment before starting a potentially cardiotoxic regimen, in order to identify individuals at greater risk of developing CV toxicities and to prevent them. Despite these recommendations, there are still no validated systems to predict cardiotoxicity risk in oncological patients. The aim of the present study was to compare the average risk assessed by conventional CV risk scores (SCORE, QRISK2, ASCVD) and two recently developed cardiotoxicity risk scores (Baseline cardiovascular risk stratification proformas, Multivariable prediction model for major adverse cardiovascular events after early stage breast cancer) in a cohort of 41 (100% female; mean age 52.9 ± 11) early breast cancer (EBC) patients treated with epirubicin and to investigate the relationship between CV and cardiotoxicity risk and the rate of CV outcome, defined as biomarkers (high sensibility Troponin I and BNP) increase during the follow-up. Results A baseline CV risk assessment was performed in all patients before starting chemotherapy according to prespecified scores, showing a higher mean CV risk in our cohort compared to general population. Most patients were at low risk of developing cardiotoxicity according to prespecified scores. During the follow-up (mean 221 ± 75 days), the primary outcome occurred in 9.8% (n = 4). The average CV risk scores of patients developing the primary outcome were higher than the controls according to both conventional and cardiotoxicity risk scores (Figure 1). The QRISK2 achieved the best ratio cases average score/controls average score (r = 3) and the ROC curve confirmed QRISK2 as the best CV risk score to predict the outcome in our cohort, reaching the highest sensitivity and specificity (Figure 2). Conclusions In a cohort of young patients affected by EBC the mean CV risk is higher than the general young female population according to traditional CV risk scores. Moreover, patients developing the primary outcome during the Follow-up were those at higher CV risk and high risk of cardio toxicity. Surprisingly the best score to predict the incidence of outcome was the QRISK2, confirming the crucial role of baseline CV risk in cancer patients.