Cardiovascular Implications of Platinum-Based Chemotherapy: Mechanisms, Clinical Manifestations, and Management

Abstract

Platinum-based chemotherapeutic agents, including cisplatin, carboplatin, and oxaliplatin, are widely used in the treatment of solid malignancies but may cause clinically important cardiovascular complications. Platinum-induced cardiotoxicity is multifactorial and involves oxidative stress, endothelial dysfunction, inflammation, mitochondrial injury, and treatment-related electrolyte disturbances. Cardiovascular manifestations may occur acutely during or shortly after chemotherapy or may develop months to years after treatment, including arrhythmias, hypertension, coronary artery disease, thromboembolic events, and heart failure. The risk is increased by advanced age, pre-existing cardiovascular disease, high cumulative chemotherapy doses, combination treatment, renal dysfunction, and lifestyle-related factors. Baseline cardiovascular assessment, regular monitoring of electrocardiography, echocardiography, biomarkers, renal function, and electrolytes, together with appropriate lifestyle and pharmacological interventions, may reduce cardiovascular risk. Management should be individualized and may require correction of reversible factors, treatment of specific cardiovascular complications, and modification of the chemotherapy regimen. Close collaboration between oncology and cardiology teams is essential for early detection, prevention, and long-term management of platinum-associated cardiotoxicity.