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

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 sub -clinical 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 ki-nase 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. (J Am Coll Cardiol CardioOnc 2023;5:22-38) (c) 2023 Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

Coronary artery disease (CAD) plays a significant role in the cardiovascular burden experienced by cancer survivors. This review highlights certain features that can guide decisions regarding the need for screening for the risk or presence of sub-clinical CAD. Screening may be appropriate for select survivors based on their risk factors and inflammatory burden. Genetic testing can provide valuable information for future CAD risk prediction tools, such as polygenic risk scores and clonal hematopoiesis markers. Factors such as cancer type and treatment also play a crucial role in determining risk, with specific implications for lifestyle interventions, atherosclerosis interventions, and potential revascularization in some cases.