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Background It is well-recognised that ischaemic heart disease remains the major leading cause of morbidity and mortality in patients with cancer due to shared risk factors and due to the pro-inflammatory or pro-thrombotic mechanism following disease itself or its treatments. Thus, early awareness and early screening of atherosclerotic disease (ASCVD) are crucial in long term risk prevention in this vulnerable patient population, especially during active oncology treatment regime.Objective Our primary objective was to identify the incidence of atherosclerotic coronary artery disease among cancer patients undergoing three major treatment regimes, including cytotoxic therapy, radiotherapy and hormonal therapy. Further objective was to standardize the specialist referral pathway for early detection of coronary events and its secondary cardio-protective measures.Methods A total of 100 patients admitted to hospital with active oncology regime from the period of January 2015 to April 2020(our study population) . Retrospectively, we analysed the total events of atherosclerosis heart disease within first week of active oncology treatment regime among the study participants. A standardized survey was conducted to identify the different types of oncology regime for different types of cancer. Among the therapeutic window, the specialist referral pathway was devised to identify the specialist cardiology team input with timely coronary interventions or optimised secondary preventive measures.Results Out of 100, 50 patients(50%) manifested with atherosclerotic heart disease. Interestingly, we identified 30 out of 50 (60%) had undergone emergency coronary angioplasty (at least one or two stents) within the same setting of oncology admission. On other hand, we found the most common types of active oncology regime which included cytotoxic chemotherapy (45%), hormonal therapy (20%) and radiotherapy (30%). The confounding factors for progressive coronary artery disease were noted as pre-existing stable angina, hypertension and hyperlipidaemia among the patients undergoing coronary intervention. However, the tendency of progressive atheromatous disease was likely due to active oncology treatment but partially due to pre-existing common thrombotic risk factors. This study highlights the gap in bridging diagnostic tools or pathways for early detection of high-risk progressive atherosclerosis disease among vulnerable patient group during the cardio-oncology admission for active treatment.Conclusion The incorporation of standardised cardiology referral with timely coronary intervention has led to significant improvement in patient quality of care 2 and potential reduction in major cardiovascular events among patients undergoing active oncology treatment regime. Future studies underpinning the role of functional or invasive coronary stratification are highlighted for early detection of atherosclerotic heart disease among vulnerable patient population.