Cancer and cardiovascular disease are the two leading causes of morbidity and mortality worldwide. Both are non-communicable diseases that frequently coexist and share overlapping risk factors, including hypertension, diabetes, obesity, hyperlipidemia, smoking, and sedentary lifestyle. As cancer survival improves, the cardiovascular consequences of cancer and its therapies have become increasingly relevant.
Despite this, cardio-oncology is still often introduced only after a patient develops a cardiac complication during cancer therapy. This reactive approach misses a critical opportunity for prevention. Increasing evidence and clinical experience suggest that early cardio-oncology involvement—before or at the start of cancer therapy—leads to better outcomes than referral after a cardiac event has occurred.
Shared Risk Factors and Baseline Vulnerability
Most patients diagnosed with cancer are not cardiovascularly “low risk.” Many have pre-existing cardiovascular disease or multiple risk factors such as hypertension, obesity, diabetes, or dyslipidemia. These conditions create baseline cardiovascular vulnerability even before treatment begins.
Cancer therapies—particularly anthracyclines, HER2-targeted agents, immune checkpoint inhibitors, and certain targeted therapies—can worsen or unmask underlying cardiovascular disease. In this setting, chemotherapy often acts as a physiologic stressor rather than the sole cause of cardiac injury. Early recognition of this risk is essential.
When Early Cardio-Oncology Referral Is Indicated
Early cardio-oncology referral is especially important for patients who:
- Have multiple cardiovascular risk factors
- Have pre-existing heart disease
- Report active or unexplained cardiac symptoms
- Have suboptimal control of cardiovascular risk factors
- Are planned to receive potentially cardiotoxic cancer therapies
Waiting for a cardiac event can lead to treatment interruptions, dose reductions, hospitalizations, and long-term cardiovascular complications—outcomes that may be preventable with earlier intervention.
Benefits of Early Involvement
Early cardio-oncology involvement allows for comprehensive cardiovascular assessment, including history, examination, laboratory testing, electrocardiography, and cardiac imaging when indicated. This approach supports individualized risk stratification rather than one-size-fits-all testing.
Importantly, early assessment enables optimization of modifiable risk factors such as blood pressure, glycemic control, lipid levels, and weight. Cancer therapies can initiate or worsen these conditions, making early recognition and management critical.
Understanding a patient’s cardiovascular profile before treatment also helps inform cancer therapy selection, monitoring strategies, and shared decision-making. Early involvement is not meant to delay cancer treatment—it supports the safe delivery of optimal oncologic care for as long as oncology teams consider necessary.
The Role of Multidisciplinary Care
Cardio-oncology thrives on collaboration. Early, structured communication between oncology and cardiology promotes individualized care plans, strengthens continuity, and reduces reactive decision-making under pressure. This multidisciplinary model benefits patients by minimizing complications while preserving treatment options.
Conclusion
Cancer and cardiovascular disease are deeply interconnected. Cardio-oncology should not be reserved for managing complications after they occur. Early involvement—particularly for high-risk patients—allows for prevention, informed treatment planning, and improved long-term outcomes.
As cancer survivorship grows, protecting cardiovascular health from the outset is no longer optional. Early cardio-oncology integration represents better, more comprehensive care across the cancer journey.
— Anusha Bhat, MD, MPH
Cardio-Oncology | Cardiovascular Disease