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Risk factors for chemotherapy-related cardiac toxicity

Polonsky, Tamar S.; DeCara, Jeanne M.

Current Opinion in Cardiology: May 2019 - Volume 34 - Issue 3 - p 283–288
doi: 10.1097/HCO.0000000000000619
CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim

Purpose of review The purpose of this review is to discuss the clinical and treatment-related factors that increase the risk of cardiotoxicity with anthracyclines and human epidermal growth factor 2 receptor inhibitors.

Recent findings Age and preexisting left ventricular dysfunction have been identified most consistently as being associated with the development of clinical heart failure or a worsening of left ventricular function with chemotherapy. Other cardiovascular conditions, including hypertension, diabetes, and coronary artery disease, are also associated with the risk of cardiotoxicity. There is growing evidence that Blacks are at a higher risk of developing cardiotoxicity than Whites, even after adjusting for known confounders. Pharmacogenomics is also emerging as a potential tool to help identify patients who are at higher risk for cardiotoxicity. Treatment-related risk factors include the dose of anthracycline or its formulation, whether the patient is receiving additional chemotherapeutic agents or radiation.

Summary Several clinical and treatment-related risk factors are associated with cardiotoxicity. Further study is needed to determine whether optimization of modifiable risk factors prior to treatment can reduce the risk of cardiotoxicity.

Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA

Correspondence to Jeanne M. DeCara, MD, UChicago Medicine, 5758 S. Maryland Ave., Chicago, IL 60637, USA. Tel: +1 773 834 7354; fax: +773 702 1034; e-mail:

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