Cisplatin, environmental metals, and cardiovascular disease: an urgent need to understand underlying mechanisms.

Significantly increased risks of cardiovascular disease occur in testicular cancer survivors given cisplatin-based chemotherapy. The postulated mechanism of platinum-based chemotherapy's vascular toxicity has been thought secondary to its different early- and late- effects on vascular injury, endothelial dysfunction, and induction of a hypercoagulable state. We highlight for the first time the similarities between platinum-associated vascular adverse events and the vascular toxicity associated with other xenobiotic-metal contaminants. The vascular toxicity seen in large epidemiologic studies of testicular cancer survivors may in part be similar and mechanistically linked to the risk seen in environmental heavy metal contaminants linked to cardiovascular disease. Future research should be directed to better understand the magnitude of the adverse cardiovascular effects of platinum and to elucidate the underlying mechanisms of action.

Cardio-oncology (London, England). 2021 Oct 10*** epublish ***

Suparna C Clasen, Paul C Dinh, Lifang Hou, Chunkit Fung, Howard D Sesso, Lois B Travis

Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indiana University, 1800 N. Capitol Ave, E308, Indianapolis, IN, 46202, USA. ., Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA., Center for Global Oncology Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA., Division of Hematology and Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY, USA., Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.