State-of-the-Art Paper
Early Breast Cancer Therapy and Cardiovascular Injury

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Although recent advances in curative-intent therapies are beginning to produce significant survival gains in early breast cancer, these improvements may ultimately be attenuated by increased risk of long-term cardiovascular mortality. This paper reviews emerging evidence on the cardiovascular effects of breast cancer adjuvant therapy and proposes a new entity that we have labeled the “multiple-hit” hypothesis. The evidence that lifestyle modification, especially exercise therapy, may mitigate these adverse effects is also reviewed. These issues are of considerable practical importance for cardiovascular clinicians, as identification and intervention in those at high risk for cardiovascular complications may reduce a major cause of mortality in women with early breast cancer.

Abbreviations and Acronyms

ACEI
angiotension-converting enzyme inhibitor
CVD
cardiovascular disease
EPC
endothelial progenitor cell
ER
estrogen receptor
HER
human epidermal growth factor receptor
HF
heart failure
LVEF
left ventricular ejection fraction
ROS
reactive oxygen species

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