The strengths of these data include their thorough observational nature, similar to a practical registry, with an excellent description of cardiovascular risk factors. Previously, there has not been a detailed assessment of cardiac risk factors and comorbidities in a cancer population, and this information enriches our understanding of how to prevent and manage cardiac disease in patients being treated for cancer. Most, if not all, prospective oncology trials do not have careful cardiovascular risk factor assessment or typical cardiac treatments delineated throughout the study, primarily because that is not the focus of these clinical trials. Additionally, cardiotoxicity in oncology treatment trials is historically defined by serial reductions in left ventricular ejection fraction, which limits the definition of cardiotoxicity, and by extension HF, to only those patients who have systolic dysfunction (3) This study, in contrast, uses International Classification of Diseases-Ninth Revision codes for HF that are more inclusive than just measurements of left ventricular ejection fraction for the detection of HF and cardiotoxicity. The limitations of this in-depth analysis indicating a benefit for statin use during chemotherapy are obviously that it was not a randomized, prospectively blinded study. The possibility that the benefit of statins demonstrated in this study could be in part related to additional use of angiotensin-converting enzyme inhibitors or beta-blockers does add a little uncertainty to determining the critical element or elements for optimal cardioprotection during cancer treatment. It would make clinical sense that angiotensin-converting enzyme inhibitors or beta-blockers may prevent the development of HF during cardiotoxic chemotherapy (4), although which therapy is truly cardioprotective on its own would require a prospective randomized study to convincingly establish the recommendation. Furthermore, using International Classification of Diseases-Ninth Revision codes to define cardiac conditions may be the best that can be done in retrospective studies but is not as accurate or complete as prospectively defining HF by acceptable criteria.