Risk stratification and primary prevention of chemotherapy cardiotoxicity

Current recommendations for the primary prevention of chemotherapy cardiotoxicity are based on stratification of the risk of cardiovascular complications before anticancer treatment is initiated. The proposed cardiotoxicity risk scores take into account the presence of existing cardiovascular diseases, but do not take into account the therapy used for these diseases. Two clinical cases of patients with tumor diseases are presented. One patient had a high risk of cardiotoxicity, but even before the detection of a tumor process, he received a β-blocker, an angiotensin receptor blocker and a statin as a treatment strategy for coronary heart disease, which are recommended for the primary prevention of cardiovascular complications of chemotherapy. In this patient, development of cardiac dysfunction during ongoing antitumor treatment was not detected. In contrast, the second patient had a low risk of cardiotoxicity and was not given cardioprotective primary prophylaxis while on chemotherapy. However, this patient developed signs of severe cardiac dysfunction. It is possible that treatment of existing cardiovascular pathology with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers and statins significantly reduce the risk of cardiotoxicity, which must be taken into account stratifying the risk of cardiotoxicity. Accordingly, it seems necessary to further improve the scales for assessing the risk of cardiotoxicity.