Routine prophylactic cardioprotective therapy should be given to all recipients at risk of cardiotoxicity from cancer chemotherapy

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.