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Canadian Journal of Cardiology

Routine Prophylactic Cardioprotective Therapy Should Not Be Given to All Recipients of Potentially Cardiotoxic Cancer Chemotherapy

      Abstract

      With growing recognition of the associations between cancer therapy and cardiotoxicity, attention has increasingly focused on the prevention of cancer therapy-related cardiovascular disease. Various strategies for cardioprotection have been proposed, including routine administration of therapies such as inhibitors of the renin-angiotensin-aldosterone system and β-blockers. We argue this approach is unsupported by the evidence and will be associated with a high likelihood of adverse effects. We highlight alternate strategies for managing this emerging issue, which focus on a targeted approach to primary prevention driven by early identification of cardiotoxicity and selective prophylaxis of patients at increased risk for developing cardiotoxicity.

      Résumé

      Le lien entre les traitements anticancéreux et la cardiotoxicité étant de plus en plus reconnu, la prévention de la maladie cardiovasculaire liée aux traitements anticancéreux suscite une attention croissante. Diverses stratégies en cardioprotection ont été suggérées, dont l’administration systématique de médicaments tels les inhibiteurs du système rénine-angiotensine-aldostérone et les bêtabloquants. Nous soutenons que cette démarche n’est appuyée par aucune donnée probante et sera associée à une forte probabilité d'effets indésirables. Dans la prise en charge de cette situation émergente, nous proposons des stratégies de rechange axées sur une démarche ciblée en prévention primaire commençant par le dépistage précoce de la cardiotoxicité et la prophylaxie sélective chez les patients exposés à un risque accru de cardiotoxicité.
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