Screening for Coronary Artery Disease in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review

Abstract

Coronary artery disease (CAD) is an important contributor to the cardiovascular burden in cancer survivors. This review identifies features that could help guide decisions about the benefit of screening to assess the risk or presence of subclinical CAD. Screening may be appropriate in selected survivors based on risk factors and inflammatory burden. In cancer survivors who have undergone genetic testing, polygenic risk scores and clonal hematopoiesis markers may become useful CAD risk prediction tools in the future. The type of cancer (especially breast, hematological, gastrointestinal, and genitourinary) and the nature of treatment (radiotherapy, platinum agents, fluorouracil, hormonal therapy, tyrosine kinase inhibitors, endothelial growth factor inhibitors, and immune checkpoint inhibitors) are also important in determining risk. Therapeutic implications of positive screening include lifestyle and atherosclerosis interventions, and in specific instances, revascularization may be indicated.

Keywords: ACS, acute coronary syndrome; AYA, adolescent and young adult; CAC, coronary artery calcium; CAD, coronary artery disease; CHIP, clonal hematopoiesis of indeterminate potential; CMR, cardiac magnetic resonance; CTA, computed tomography angiography; CVD, cardiovascular disease; IGF, insulin-like growth factor; LDL, low-density lipoprotein; PCE, pooled cohort equations; PCI, percutaneous coronary intervention; PRS, polygenic risk score; ROS, reactive oxygen species; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor; calcification; coronary artery calcium; coronary artery disease; prevention; risk factor; risk prediction.