Long-term arterial complications of chemotherapy in patients with cancer

• The number of cancer survivors has gradually increased in recent decades
• Cardiovascular toxicity of cancer treatment negatively influences outcome of the cancer survivor
• Some endothelial injury occurring during treatment set the stage for later (sub)clinical vascular events
• A lifetime cardiovascular risk approach aims at early intervention for optimal control of risk factors
• Guidelines for cancer treatment taking vascular conditions into account need to be developed

ABSTRACTThe number of cancer survivors has gradually increased in recent decades. However, the cancer survivors are at risk for conditions related to their initial disease and its treatment, i.e. surgery, systemic treatment or radiotherapy. Cardiovascular complications, such as myocardial infarction, are common side effects of these therapies. Cardiovascular damage can occur during treatment or month to years after the initial treatment, as late effect of the cancer treatment. The pathophysiology of these effects is not yet fully understood, but an important part of the cardiovascular complications are thought to be the result of effects of anticancer agents on the structural and functional properties of the endothelium. Because these conditions can result in a high degree of morbidity and mortality, understanding how to improve the prevention, recognition, and treatment of vascular disease is an important medical priority in the care for cancer survivors. This review will focus on the long-term arterial complications of chemotherapy in cancer survivors. It will summarize the epidemiology and pathophysiology of these complications. Furthermore, important long-term clinical conditions related to these effects will be outlined, including cardiovascular risk management in terms of prevention, evaluation and therapy.