Cancer Cachexia and the Heart: A Review with Focus on China

Cancer cachexia is a systemic, multifactorial syndrome characterized by progressive depletion of skeletal muscle, disruption of metabolic homeostasis, and reduced survival. In experimental models, cachexia-associated mediators, including inflammatory cytokines, myostatin-related signaling, and proteolytic activation, have been implicated in driving cardiac atrophy, interstitial fibrosis, and impaired myocardial function. Conversely, data from chronic heart failure suggest that reduced tissue perfusion, neurohormonal activation, and sustained inflammation secondary to cardiac dysfunction may further aggravate skeletal muscle wasting. These observations suggest a bidirectional relationship between cancer cachexia and cardiac dysfunction, which has not been tested in patients with cancer. Approximately 4.82 million new cancer cases occur in China annually, with a disease distribution predominated by gastrointestinal, hepatobiliary, and thoracic malignancies, all of which carry high risks of cachexia. Among 710,170 Chinese patients with cancer, 5.0% had cardiovascular disease and 13.0% had at least one cardiovascular risk factor. These figures indicate a large population at risk, but they do not show that cardiac involvement in Chinese patients differs in frequency, phenotype, or clinical impact from that in other populations; to our knowledge, no prospective data on cancer-associated cardiac involvement have been reported for Chinese patients, and cachexia assessment does not include cardiac biomarkers or echocardiographic measures. This review summarizes cancer cachexia epidemiology in China, shows the evidence linking cachexia to cardiac wasting, and evaluates how cardiac dysfunction may in turn influence the cachectic trajectory. Accordingly, we outline the key clinical and mechanistic questions that remain unanswered in Chinese patients and propose a research agenda in which cardiac assessment is evaluated prospectively before it is considered for routine care.