Risk-guided cardioprotection in cardio-oncology

The cardiotoxic effects of cancer therapies are well established, and the most clinically relevant consequences include heart failure and cardiomyopathy. As such, efforts have been focused on developing strategies to attenuate the risk of cardiovascular dysfunction in patients receiving potentially cardiotoxic therapies. Randomized trials to identify cardioprotective approaches have largely selected patients on the basis of cancer type and treatment regimen, regardless of baseline or dynamic changes in cardiovascular risk. However, contemporary evidence suggests that this approach results in modest to no significant benefit on subclinical or clinical measures of cardiotoxicity. We hypothesize that a risk-guided cardioprotection approach can enable the delivery of targeted therapy to those who may derive the greatest cardiovascular benefit, avoiding unnecessary treatment of lower-risk populations. Here, we review the contemporary literature on primary cardioprotection and present recent studies in cardio-oncology focused on risk-guided cardioprotection to support the implementation of more tailored strategies.