Breast cancer chemotherapy vascular toxicity: a review of mediating mechanisms and exercise as a potential therapeutic

Marie McLaughlin*, Geraint Florida-James, Mark Ross

*Corresponding author for this work

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Breast cancer chemotherapy, although very potent against tumour tissue, results in significant cardiovascular toxicity. The focus of research in this area has been predominantly towards cardiotoxicity. There is limited evidence detailing the impact of such treatment on the vasculature despite its central importance within the cardiovascular system and resultant detrimental effects of damage and dysfunction. This review highlights the impact of chemotherapy for breast cancer on the vascular endothelium. We consider the most likely mechanisms of endothelial toxicity to be through direct damage and dysfunction of the endothelium. There are sharp consequences of these detrimental effects as they can lead to cardiovascular disease. However, there is potential for exercise to alleviate some of the vascular toxicity of chemotherapy, and the evidence for this is provided. The potential role of exercise in protecting against vascular toxicity is explained, highlighting the recent in-human and animal model exercise interventions. Lastly, the mediating mechanisms of exercise protection of endothelial health is discussed, focusing on the importance of exercise for endothelial health, function, repair, inflammation and hyperlipidaemia, angiogenesis, and vascular remodelling. These are all important counteracting measures against chemotherapy-induced toxicity and are discussed in detail.
Original languageEnglish
Pages (from-to)R106-R120
Number of pages15
JournalVascular Biology
Issue number1
Early online date12 Nov 2021
Publication statusPublished - 2021
Externally publishedYes


  • chemotherapy
  • cardiovascular toxicity
  • vasculo-oncology
  • endothelium
  • exercise
  • cardio-oncology


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