We have read with considerable interest the scientific letter by Caballero Valderrama et al.1 regarding anthracycline-related onset of ventricular dysfunction associated with familial dilated cardiomyopathy. The early diagnosis and management of the cardiovascular toxicity associated with anticancer drugs is an ever-growing challenge, from both clinical and research perspectives. Undoubtedly, the risk of cardiovascular toxicity is the result of a complex interaction among the characteristics of both the patient (eg, age, genetics, and cardiovascular risk) and the tumor itself, as well as the type and length of the proposed treatment.2

Current cardio-oncology strategies recommend individualized assessment of the cardiovascular toxicity risk in all patients who may be receiving potentially cardiotoxic anticancer therapies.3 Based on this risk, prevention and monitoring protocols have been established for during and after the cancer treatment, as well as recommendations for optimizing the management of related cardiovascular events.4,5

We consider highly pertinent the publication of this late example of cardiovascular disease related to anthracyclines and radiotherapy1,2 because it reminds clinicians that they should consider cancer treatment to be a cardiovascular risk factor3 and because it exemplifies the need for multidisciplinary teams coordinating among the different levels of care.

We agree with the authors that the performance of a genetic study in patients with a family history compatible with heart disease could improve the prevention of cardiotoxicity risk. However, in terms of genetics and personalized medicine in cardio-oncology, there is still a long way to go.3,6 Until then, cardiovascular risk should be stratified before, during, and after cancer treatment to optimize the control of cardiovascular risk factors and detect subclinical phases of myocardial damage. In line with the current consensus, the reported patient had an intermediate risk of anthracycline-related toxicity, and the combination of anthracycline with radiotherapy would increase this risk in the mid-to-long–term.4,5 In this regard, monitoring of biomarkers,7 electrocardiography, and imaging techniques8 before, during, and 12 months after treatment completion could have detected subclinical changes in cardiac function requiring a more detailed long-term follow-up.5,6 Based on the authors’ report, the electrocardiographic changes could have predicted the cardiac damage.1 The cardiovascular monitoring of cardiotoxic treatments4 is a class I recommendation with level of evidence B in the 2021 European guidelines on cardiovascular disease prevention3 and most of the tests mentioned are easily accessed.

Ultimately, all of this underlines the importance of the creation of multidisciplinary programs and pragmatic intervention protocols permitting the optimal screening and follow-up of cardiovascular disease in cancer patients to improve their outcomes and facilitate their treatment.