Air Pollution and Cardiac Remodeling and Function in Patients With Breast Cancer

Cardiac dysfunction remains an important concern among patients with breast cancer treated with anthracyclines and/or trastuzumab. Although these therapies have substantially improved cancer survival,¹ they are also associated with a risk of adverse cardiac remodeling, declines in left ventricular (LV) ejection fraction (LVEF), and clinically overt heart failure (HF).^2–5 Identification and mitigation of potentially modifiable cardiovascular risk factors is thus important for improving the cardiovascular health of this growing population. While much of the field of cardio-oncology has focused on clinical cardiovascular risk factors (eg, hypertension, diabetes, and hyperlipidemia), the associations between environmental factors and cardiac function and remodeling in cancer remain undefined. Air pollution has emerged as a major contributor to global morbidity and mortality, with nearly 6.7 million deaths worldwide attributed to air pollution in 2019 alone.