Landscape of non-coding RNAs in cancer treatment-induced cardiovascular toxicity: From mechanistic insights to clinical implications

Non-coding RNAs (ncRNAs) are increasingly recognized as crucial regulators in the pathophysiology of cancer treatment–induced cardiovascular toxicity, which largely stems from their capacity to orchestrate a wide range of gene expression networks. Emerging evidence has uncovered complex and critical functions of ncRNAs, including microRNAs, long non-coding RNAs, and circular RNAs, in mediating cardiotoxicity during cancer treatment. Here, we revisit the mechanisms of major anti-cancer treatment modalities and detail how they may lead to cardiovascular toxicity, which involves a myriad of key, interconnected processes, such as apoptosis, DNA damage, oxidative stress, mitochondrial damage, and autophagy. We further underscore the pivotal roles of ncRNAs within the cardio-oncology landscape mechanistically and analyze their clinical potentials to predict, detect, and treat cardiovascular damage in oncology settings. With this review, we aim to provide a comprehensive and up-to-date landscape of ncRNAs in the rapidly revolving field of cancer treatment–related cardiovascular toxicity, highlighting how such fundamental discoveries may guide future clinical applications.