. Author manuscript; available in PMC: 2022 Jan 21.

Published in final edited form as: Nat Rev Cardiol. 2020 Mar 26;17(8):503–522. doi: 10.1038/s41569-020-0347-2

Table 3 |.

Overview of the three principal presentations of arterial vascular toxic effects of cancer therapy

Characteristics	Main presentation
Characteristics	Acute vasospasm	Acute thrombosis	Accelerated atherosclerosis
Onset after start of cancer therapy	Days to weeks	Weeks to months	Months to years
Reversibility	Very likely	Likely	Very unlikely
Primary culprit	Vascular smooth muscle cells	Endothelial cells	Endothelial cells
Secondary culprit	Endothelial cells	Platelets	Bone marrow-derived cells, pro-inflammatory cells
High levels of circulating endothelial cells	Possible	Yes	Yes
Low levels of endothelial progenitor cells	Possible	Yes	Yes
Procoagulant microvesicles	No	Yes	No
Examples of cancer therapeutics	5-Fluorouracil, capecitabine, platinum drugs, VEGF inhibitors	Platinum drugs, bleomycin, vinca alkaloids, VEGF inhibitors, ICIs	Nilotinib, ponatinib, cisplatin, VEGF inhibitors
Treatment	Nitrates, calcium-channel blockers	Thrombectomy, PTCA and/or stent, DAPT, statin therapy	Revascularization, aspirin, statins, amlodipine, ACE inhibitor, exercise
On-therapy screening	Signs and symptoms	Signs and symptoms	Signs and symptoms
On-therapy screening	Vasoreactivity studies, ECG (ST-segment elevation) monitoring	vWF levels, circulating endothelial cell and/or endothelial progenitor cell levels	Ankle–brachial index, cardiac stress test, coronary CT angiography
Pre-therapy screening and prevention	Prophylactic therapy with nitrates and calcium-channel blockers	DAPT, statins	Strict risk factor control, especially lipids, (anti-IL-1β), aspirin, statins and/or other therapies
Pre-therapy screening and prevention	CVD risk stratification: risk factors and/or disease, testing for subclinical ASCVD and/or abnormal vasoreactivity, including endothelial dysfunction	CVD risk stratification: risk factors, testing for subclinical ASCVD, endothelial dysfunction, vWF levels	CVD risk stratification: risk factors, testing for subclinical ASCVD

ACE, angiotensin-converting enzyme; ASCDV, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; DAPT, dual antiplatelet therapy; ECG, electrocardiogram; ICI, immune checkpoint inhibitor; PTCA, percutaneous transluminal coronary angioplasty; VEGF, vascular endothelial growth factor; vWF, von Willebrand factor.