Table 2.

Risk factors for anthracycline-related cardiotoxicity^a

Risk factor	Comment	References
Cumulative anthracycline dose	Cumulative doses >300 mg/m2 are associated with significantly elevated long-term risk	3, 12, 96–98
Time after therapy	The incidence of clinically important cardiotoxicity increases progressively over decades	3, 7, 12, 97
Rate of anthracycline administration	Continuous infusion not cardioprotective in children	7, 78
Individual anthracycline dose	Higher individual doses are associated with increased late cardiotoxicity, even when cumulative doses are limited; no dose is risk-free	12, 61, 97
Type of anthracycline	Liposomal encapsulated preparations may reduce cardiotoxicity. Data on anthracycline analogues and differences in cardiotoxicity are conflicting	85, 86, 99
Radiation therapy	Cumulative cardiac radiation dose >30 Gy before or concomitant with anthracycline treatment; as little as 5 Gy increases the risk	7, 14, 98, 100
Concomitant therapy	Trastuzumab, cyclophosphamide, bleomycin, vincristine, amsacrine, and mitoxantrone, among others, may increase susceptibility or toxicity	99, 100
Preexisting cardiac risk factors	Hypertension; ischemic, myocardial, and valvular heart disease; prior cardiotoxic treatment	99
Personal health habits	Smoking; consumption of alcohol, energy drinks, stimulants, prescription and illicit drugs	7
Comorbidities	Diabetes, obesity, renal dysfunction, pulmonary disease, endocrinopathies, electrolyte and metabolic abnormalities, sepsis, infection, pregnancy, viruses, elite athletic participation, low vitamin D concentrations	7, 46, 51, 95, 99
Age	Both young (<1 year) and advanced age at treatment are associated with elevated risk	3, 7, 97, 98
Sex	Females are at greater risk than males	61, 97
Complementary therapies	More information needs to be collected to assess risk	7
Additional factors	Trisomy 21; African American ancestry	96

^aAdapted from Reference 47 with permission from BMJ Publishing Group Ltd.