Grounding Cardio-Oncology in Basic and Clinical Science
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The development of cardio-oncology as a clinical field has been driven by improved therapeutics resulting in a dramatic increase in the number of cancer survivors (≈15 500 000 in the United States alone) many of whom experience cardiovascular complications related to their cancer treatments.1 Both traditional and targeted therapies can affect the cardiovascular system, resulting in hypertension, heart failure, myocarditis, arrhythmias, vascular disease, and thrombosis. Although recurrence of cancer is the eventual cause of death in many cancer survivors, cardiovascular disease is responsible for substantial morbidity and mortality in this population. Thus, effective means of mitigating cardiovascular complications of cancer therapies would have substantial impact on health. Unfortunately, definitive strategies to predict, prevent, monitor, and treat chemotherapy-induced cardiovascular syndromes are currently lacking for several reasons. First, mechanistically distinct cancer therapies can cause heterogeneous cardiovascular sequelae. Second, molecular mechanisms that mediate these syndromes are poorly understood. Last, evidence-based knowledge pertaining to some of the most important clinical questions is not yet available. Because of this situation, most clinical guidelines are based on consensus statements.
To illustrate how gaps in basic and clinical knowledge may combine to produce suboptimal disease models on which to base diagnosis and treatment strategies, consider the concept of type I versus type II cardiomyopathy.2 This paradigm was introduced in 2005 to contrast heart failure syndromes resulting from doxorubicin and trastuzumab. …