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Table 5 Levels of Evidence for methods of prevention of cardiovascular disease related to cancer treatment

From: Evidence-based prediction and prevention of cardiovascular morbidity in adults treated for cancer

Timing Intervention Effect Level of Evidence Reference
Pre-treatment Use of predictive models for future CVD Risk groups to predict rate of cardiac events during 3 year follow-up after curative (HER2+) BC treatment 2b [15]
During treatment ACEi/ARB Mean difference in delta LVEF −2.36% in pts. with early HER2+/− BC 1a [28]
  Beta-blocker 2,6% lower incidence of LVEF < 50% compared to placebo, NNT 38 1a [29]
  Statins No difference in LVEF < 50% 1b [39]
  Aspirin/anticoagulants n.a. n.a.  
  Other drugs; dexrazoxane Reduces risk of CHF and cardiac events 1a [40]
  Other drugs; sildenafil No difference LVEF-declines 1b [42]
  Smoking cessation Circumstantial: smokers increased reisk for cardiac toxicity related to radiotherapy n.a.  
  Weight loss Circumstantial: reduction non-BC mortality in BC survivors n.a.  
  Physical exercise Hypothesis generating for ongoing RCT’s 5  
Post treatment Primary prevention Indirect evidence from general population n.a.  
  1. Abbreviations: CVD cardiovascular disease, HER2 Human Epidermal growth Receptor 2, ACEi ACE-inhibitor, ARB angiotensin receptor blocker, LVEF left ventricular ejection fraction, n.a. not available, BC breast cancer, RCT’s randomized controlled trials, CHF clinical heart failrure