Would you consider starting an ACE inhibitor on a patient without CVD or heart failure prior to initiation of anthracyclines to reduce the overall risk of myocardial toxicity?

Even though the patient does not have CVD or heart failure history, there are still factors to consider if they are at higher risk for anthracycline cardiac toxicity: Lower EF at baseline, significant valvular heart disease, prehypertension/hypertension, diabetes, obesity, advanced age, any subclini...

Based on recent data presented at ACC.23/WCC I would probably initiate statin Rx (STOP CA trial).

In the absence of HTN, DM, CAD and normal baseline LVEF, I don’t think there is a role for routine ACEi/carvedilol use.