The co-occurrence of cancer and heart failure (HF) represents a significant clinical drawback as each disease interferes with the treatment of the other. In addition to shared risk factors, a growing body of experimental and clinical evidence reveals numerous commonalities in the biology underlying both pathologies. Inflammation emerges as a common hallmark for both diseases as it contributes to the initiation and progression of both HF and cancer. Under stress, malignant and cardiac cells change their metabolic preferences to survive, which makes these metabolic derangements a great basis to develop intersection strategies and therapies to combat both diseases. Furthermore, genetic predisposition and clonal haematopoiesis are common drivers for both conditions and they hold great clinical relevance in the context of personalized medicine. Additionally, altered angiogenesis is a common hallmark for failing hearts and tumours and represents a promising substrate to target in both diseases. Cardiac cells and malignant cells interact with their surrounding environment called stroma. This interaction mediates the progression of the two pathologies and understanding the structure and function of each stromal component may pave the way for innovative therapeutic strategies and improved outcomes in patients. The interdisciplinary collaboration between cardiologists and oncologists is essential to establish unified guidelines. To this aim, pre-clinical models that mimic the human situation, where both pathologies coexist, are needed to understand all the aspects of the bidirectional relationship between cancer and HF. Finally, adequately powered clinical studies, including patients from all ages, and men and women, with proper adjudication of both cancer and cardiovascular endpoints, are essential to accurately study these two pathologies at the same time.

1st Department Medicine Cardioangiology University Hospital and Medical Faculty Hradec Kralove Czech Republic

Cardio Oncology Center of Excellence Cardiovascular Division Washington University in St Louis St Louis MO USA

Cardio Oncology Clinic Heart Failure Unit Department of Cardiology Athens University Hospital 'Attikon' National and Kapodistrian University of Athens Medical School Athens Greece

Cardio Oncology Service Royal Brompton Hospital and National Heart and Lung Institute Imperial College London London UK

Cardio Oncology Unit Department of Cardiology University of Heidelberg Heidelberg Germany

Cardiovascular Disease Unit IRCCS Ospedale Policlinico San Martino Genoa Italy

Cardiovascular Division Cardio Oncology Program Department of Medicine University of Minnesota Medical School Minneapolis MN USA

Center for Molecular Medicine Maine Medical Center Research Institute Maine Medical Center Scarborough ME USA

CIBER Cardiovascular Instituto de Salud Carlos 3 Madrid Spain

CIC1418 and DMU CARTE AP HP Hôpital Européen Georges Pompidou Paris France

Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Comprehensive Heart Failure Center University Clinic Würzburg Würzburg Germany

Department of Cardiology and Angiology Hannover Medical School Hannover Germany

Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies Berlin Germany

Department of Cardiology and Pneumology Heart Center University of Göttingen Medical Center Göttingen Germany

Department of Cardiology CARIM School for Cardiovascular Diseases Faculty of Health Medicine and Life Sciences Maastricht University Maastricht The Netherlands

Department of Cardiology University Hospital Zurich University Heart Center Zurich Switzerland

Department of Cardiology University Medical Center Groningen Groningen The Netherlands

Department of Cardiovascular Sciences Centre for Molecular and Vascular Biology KU Leuven Leuven Belgium

Department of Heart Diseases Wroclaw Medical University and Centre for Heart Diseases University Hospital Wroclaw Poland

Department of Internal Medicine 3 University of Kiel Kiel Germany

Department of Internal Medicine and Center of Excellence for Biomedical Research University of Genova Genoa Italy

Department of Medical Oncology National Center for Tumor Diseases University Hospital Heidelberg Heidelberg Germany

Department of Medicine Universitat Autònoma de Barcelona Barcelona Spain

Department of Translational Medical Sciences and Interdepartmental Center of Clinical and Translational Research Federico 2 University Naples Italy

Departments of Medicine and Cell Biology Wilf Family Cardiovascular Research Institute Albert Einstein Cancer Center Albert Einstein College of Medicine New York NY USA

Division Heart and Lungs and Regenerative Medicine Centre University Medical Centre Utrecht and Utrecht University Utrecht The Netherlands

Division of Cardiovascular Medicine and Oncology Cardio Oncology Program Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center Nashville TN USA

DKFZ Heidelberg Germany

DZHK partner site Hamburg Kiel Lübeck Germany

DZHK partner site Heidelberg Mannheim Germany

Emergency Institute for Cardiovascular Diseases 'Prof C C Iliescu' University of Medicine Carol Davila Bucharest Romania

German Center for Cardiovascular Research partner site Göttingen Göttingen Germany

Heart Failure Unit and Cardiology Department Hospital Universitari Germans Trias i Pujol CIBERCV Badalona Spain

Heart Failure Unit Cardiology G da Saliceto Hospital Piacenza University of Parma Parma Italy

Innate Pharma Marseille France

Institute of Experimental Cardiology Heidelberg University Hospital Heidelberg Germany

Institute of Experimental Pharmacology and Toxicology University Medical Center Hamburg Eppendorf Hamburg Germany

Institute of Molecular and Translational Therapeutic Strategies Hannover Medical School Hannover Germany

Medical University of Graz University Heart Center Division of Cardiology Graz Austria

Partner Site Hamburg Kiel Lübeck DZHK Hamburg Germany

Royal Marsden NHS Foundation Trust London UK

San Raffaele Pisana Scientific Institute Rome Italy

School of Pharmaceutical Sciences University of Geneva Institute of Pharmaceutical Sciences of Western Switzerland University of Geneva Geneva Switzerland

Swiss Cardiovascular Centre Bern University Bern Switzerland

Translational Research Center in Oncohaematology Geneva Switzerland

Université de Paris PARCC INSERM Paris France

University of Belgrade Faculty of Medicine Serbian Academy of Sciences and Arts Belgrade Serbia

University of Cyprus Medical School Nicosia Cyprus

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$a de Boer, Rudolf A $u Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands

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$a Common mechanistic pathways in cancer and heart failure. A scientific roadmap on behalf of the Translational Research Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) / $c RA. de Boer, JS. Hulot, CG. Tocchetti, JP. Aboumsallem, P. Ameri, SD. Anker, J. Bauersachs, E. Bertero, AJS. Coats, J. Čelutkienė, O. Chioncel, P. Dodion, T. Eschenhagen, D. Farmakis, A. Bayes-Genis, D. Jäger, EA. Jankowska, RN. Kitsis, SH. Konety, J. Larkin, L. Lehmann, DJ. Lenihan, C. Maack, JJ. Moslehi, OJ. Müller, P. Nowak-Sliwinska, MF. Piepoli, P. Ponikowski, R. Pudil, PP. Rainer, F. Ruschitzka, D. Sawyer, PM. Seferovic, T. Suter, T. Thum, P. van der Meer, LW. Van Laake, S. von Haehling, S. Heymans, AR. Lyon, J. Backs

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$a The co-occurrence of cancer and heart failure (HF) represents a significant clinical drawback as each disease interferes with the treatment of the other. In addition to shared risk factors, a growing body of experimental and clinical evidence reveals numerous commonalities in the biology underlying both pathologies. Inflammation emerges as a common hallmark for both diseases as it contributes to the initiation and progression of both HF and cancer. Under stress, malignant and cardiac cells change their metabolic preferences to survive, which makes these metabolic derangements a great basis to develop intersection strategies and therapies to combat both diseases. Furthermore, genetic predisposition and clonal haematopoiesis are common drivers for both conditions and they hold great clinical relevance in the context of personalized medicine. Additionally, altered angiogenesis is a common hallmark for failing hearts and tumours and represents a promising substrate to target in both diseases. Cardiac cells and malignant cells interact with their surrounding environment called stroma. This interaction mediates the progression of the two pathologies and understanding the structure and function of each stromal component may pave the way for innovative therapeutic strategies and improved outcomes in patients. The interdisciplinary collaboration between cardiologists and oncologists is essential to establish unified guidelines. To this aim, pre-clinical models that mimic the human situation, where both pathologies coexist, are needed to understand all the aspects of the bidirectional relationship between cancer and HF. Finally, adequately powered clinical studies, including patients from all ages, and men and women, with proper adjudication of both cancer and cardiovascular endpoints, are essential to accurately study these two pathologies at the same time.

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