Cardiovascular disease and cancer are the two leading causes of morbidity and mortality in the world. The emerging field of cardio-oncology has revealed that these seemingly disparate disease processes are intertwined, owing to the cardiovascular sequelae of anticancer therapies, shared risk factors that predispose individuals to both cardiovascular disease and cancer, as well the possible potentiation of cancer growth by cardiac dysfunction. As a result, interest has increased in understanding the fundamental biological mechanisms that are central to the relationship between cardiovascular disease and cancer. Metabolism, appropriate regulation of energy, energy substrate utilization, and macromolecular synthesis and breakdown are fundamental processes for cellular and organismal survival. In this Review, we explore the emerging data identifying metabolic dysregulation as an important theme in cardio-oncology. We discuss the growing recognition of metabolic reprogramming in cardiovascular disease and cancer and view the novel area of cardio-oncology through the lens of metabolism.
Metabolic remodelling is a defining feature of both cardiovascular diseases and tumours.
Metabolic dysregulation of cancer cells extends beyond the tumour microenvironment and can lead to both systemic and cardiac-specific consequences.
Cardiovascular disease and cancer share several risk factors, including diabetes mellitus, dyslipidaemia, cachexia and an impaired immune response.
Anticancer therapies can result in adverse cardiac events, including acute myocardial infarction and heart failure.
Targeting metabolic features of cancer cells might limit tumour growth and also protect the heart against adverse remodelling.
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A.K. is supported by NIH award R00-HL-1417. J.M. is supported by NIH grants R01HL141466, R01HL155990 and R01HL156021. R.A.d.B. is supported by a grant from the European Research Council (ERC CoG 818715, SECRETE-HF) and by grants from the Netherlands Heart Foundation (grants 2017-21; 2017-11; 2018-30; 2020B005).
J.M. has served on advisory boards for Amgen, AstraZeneca, Audentes, Boston Biomedical, Bristol Myers Squibb, Cytokinetics, Deciphera, Immunocore, Ipsen, Janssen, Myovant, Precigen Triple-Gene, Regeneron and Takeda. R.A.d.B. reports research grants from Abbott, AstraZeneca, Boehringer Ingelheim, Cardior Pharmaceuticals, Ionis Pharmaceuticals, Novo Nordisk and Roche; and reports speaker fees from Abbott, AstraZeneca, Bayer, Novartis and Roche. A.K. declares no competing interests.
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Karlstaedt, A., Moslehi, J. & de Boer, R.A. Cardio-onco-metabolism: metabolic remodelling in cardiovascular disease and cancer. Nat Rev Cardiol 19, 414–425 (2022). https://doi.org/10.1038/s41569-022-00698-6
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