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Canadian Journal of Cardiology

Routine Prophylactic Cardioprotective Therapy Should Be Given to All Recipients at Risk of Cardiotoxicity From Cancer Chemotherapy

  • Author Footnotes
    ∗ Husam Abdel-Qadir and Mark T. Nolan are co-first authors.
    Husam Abdel-Qadir
    Footnotes
    ∗ Husam Abdel-Qadir and Mark T. Nolan are co-first authors.
    Affiliations
    Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ Husam Abdel-Qadir and Mark T. Nolan are co-first authors.
    Mark T. Nolan
    Footnotes
    ∗ Husam Abdel-Qadir and Mark T. Nolan are co-first authors.
    Affiliations
    Menzies Institute for Medical Research, Hobart, Australia
    Search for articles by this author
  • Paaladinesh Thavendiranathan
    Correspondence
    Corresponding author: Dr Paaladinesh Thavendiranathan, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University of Toronto, 4N-490, 585 University Ave, Toronto, Ontario M5G 2N2, Canada. Tel.: +1-416-340-5326; fax: +1-416-340-3640.
    Affiliations
    Division of Cardiology, Peter Munk Cardiac Centre and the Joint Division of Medical Imaging, Ted Rogers Program in Cardiotoxicity Prevention, University Health Network, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ Husam Abdel-Qadir and Mark T. Nolan are co-first authors.
Published:April 26, 2016DOI:https://doi.org/10.1016/j.cjca.2016.04.010

      Abstract

      The inevitability of cardiac injury in many patients treated for cancer mandates strategies to mitigate the effect of cancer treatment on the heart. In this article we argue that the best approach to prevent cardiotoxicity is universal primary prevention for everyone at risk for irreversible myocardial injury. Our viewpoint is on the basis of 5 major arguments that we discuss in detail in this article. We outline the shortcomings of alternate strategies for prevention and highlight that the strongest existing evidence today supports our viewpoint. In particular, data from multiple randomized controlled trials indicate that most patients who receive anthracyclines are at risk, and should be accordingly considered for primary prevention.

      Résumé

      Comme les lésions cardiaques sont inévitables chez bon nombre de patients recevant un traitement anticancéreux, il est nécessaire de mettre en place des stratégies pour atténuer les effets de ce type de traitement sur le cœur. Dans cet article, nous soutenons que le meilleur moyen de prévenir la cardiotoxicité est la prévention primaire systématique chez les patients à risque de lésion myocardique irréversible. Notre position est étayée par 5 arguments importants présentés en détail dans cet article. Nous soulignons les faiblesses des autres stratégies et le fait que les données existantes les plus probantes corroborent notre point de vue. Il est particulièrement à noter que les données provenant de multiples études contrôlées à répartition aléatoire indiquent que la plupart des patients qui reçoivent des anthracyclines sont exposés à un risque et, par conséquent, il faudrait, dans ces cas, envisager la prévention primaire.
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