Progression of coronary heart disease in cancer patients: the impact of antitumor therapy, as well as the malignant process (literature review)

Results. This analytical review provides a comprehensive assessment of current Russian and international scientific literature focused on the problem of coronary artery disease progression in cancer patients. The literature search was conducted in authoritative domestic and international databases, including PubMed, Scopus, Elsevier, Cochrane Library, Clinical Evidence, Best Evidence, and RSCI, ensuring the representativeness and reliability of the data presented. The relevance of this issue is underscored by a significant increase in the frequency of cardiovascular complications in patients with malignant neoplasms, which is directly linked to both the direct effects of anticancer therapy and the indirect influence of the cancer itself. The review details the key pathogenetic mechanisms contributing to the development and exacerbation of coronary artery disease: Direct cardiotoxicity of anticancer drugs: Particular attention is paid to anthracyclines, which induce oxidative stress and cardiomyocyte apoptosis, leading to myocardial dysfunction. VEGF inhibitors are associated with the development of arterial hypertension and thromboembolic complications, as well as direct damage to the endothelium of coronary arterioles, impairing vasodilatory reserve. HER2-targeted drugs, in turn, can block crucial pathways for cardiomyocyte survival and repair. Systemic effects of the malignant process: Tumor progression is accompanied by chronic systemic inflammation, the release of pro-inflammatory cytokines, and a prothrombotic state, which accelerates atherothrombosis and endothelial dysfunction. Furthermore, the work analyzes epidemiological data on the frequency of coronary artery disease progression and identifies key risk factors in oncology patients, including comorbid conditions (e.g., hypertension, diabetes), cumulative doses of chemotherapeutic agents, the type of targeted therapy received, and the baseline state of the cardiovascular system. Conclusion. Thus, the conducted analysis confirms that the problem of coronary artery disease progression in cancer patients requires a multidisciplinary approach (onco-cardiology) and the development of strategies for active monitoring, early diagnosis of microvascular dysfunction, and cardioprotection at all stages of anticancer treatment.