Cardiovascular toxicity of anticancer drugs: the dark side of success

Cancer represents the second cause of death in the European Union after cardiovascular diseases, accounting for 27% of all deaths. Anticancer drugs (ACDs) have poor cell selectivity and a narrow therapeutic margin, in such a way that small increases in their plasma levels lead to the appearance of adverse reactions in multiple tissues. The FACs can produce a wide range of adverse cardiovascular reactions (named cardiotoxicity) that increase morbidity and can even lead to death in some patients whose cancer has been cured by the ACD. The risk of cardiotoxicity increases with age, and since up to two-thirds of cancer patients are older than 65 years of age, cancer, cardiovascular diseases whose incidence increases with age and CAD-induced cardiotoxicity will coexist in this population. The diagnosis, prognosis, follow-up, and treatment of cardiotoxicity induced by CAFs represent a challenge in daily clinical practice that makes teamwork among cardiologists, oncologists, and hematologists essential. The recent guidelines on cardio-oncology of the European Society of Cardiology represents the first experience of this joint work to comprehensively address the cardiotoxicity due to anticancer drugs.