Cancer and
cardiovascular diseases, including
heart failure (HF), are the main causes of death in Western countries. Several anticancer drugs and
radiotherapy have adverse effects on the cardiovascular system, promoting
left ventricular dysfunction and ultimately HF. Nonetheless, the relationship between
cancer and HF is likely not unidirectional. Indeed,
cancer and HF share common risk factors, and both have a bidirectional relationship with systemic
inflammation, metabolic disturbances, and neurohormonal and immune activation. Few studies have assessed the impact of untreated
cancer on the heart. The presence of an active
cancer has been associated with elevated cardiac
biomarkers, an initial impairment of left ventricular structure and function, autonomic dysfunction, and reduced exercise tolerance. In turn, these conditions might increase the risk of cardiac damage from
chemotherapy and
radiotherapy. HF drugs such as beta-blockers or inhibitors of the renin-angiotensin-aldosterone system might exert a protective effect on the heart even before the start of
cancer therapies. In this review, we recapitulate the evidence of cardiac involvement in
cancer patients naïve from
chemotherapy and
radiotherapy and no history of
cardiac disease. We also focus on the perspectives for an early diagnosis and treatment to prevent the progression to cardiac dysfunction and clinical HF, and the potential benefits of
cardioactive drugs on
cancer progression.