It is interesting that the initial unadjusted analysis suggested that anthracyclines may be protective even for the incidence of HF or CM, but after adjustments, a modest increase risk for HF or CM was identified. One might question the fact that, if no left ventricular function assessment or other testing were performed, then an International Classification of Disease-9th Revision-Clinical Modification, diagnosis of HF or CM never would be recorded. It seems likely that this observation is the case largely because past anthracycline use is not commonly considered a major risk for the development of HF in a typical cardiology or oncology practice, and an assessment of left ventricular function is not routinely performed. As a result, no diagnosis of HF or CM would be made in that case. Furthermore, as soon as left ventricular dysfunction is identified, patients do not seem to be treated optimally with cardiac medications, as frequently as we might expect (3). However, trastuzumab initially was believed to greatly increase the risk of HF or CM, and serial testing during treatment is widely recommended and practiced, especially in research trials. This may explain why trastuzumab had such a higher treatment-emergent HF rate than anthracyclines, but generally this therapy is not considered to be as damaging as an anthracycline. Another fascinating observation from these data includes the fact that hyperlipidemia was protective for the development of HF or CM. It could be theorized that because hyperlipidemia was identified and presumably treated, these patients likely were taking statin medications that are protective against the progression of HF (4). Further analysis of this concept is needed.