Common Heart Medications Could Prevent Cardiotoxicity in Cancer Patients

Sergio Moral, MD, PhD

A meta-analysis presented at EuroEcho 2019 is suggesting cardiotoxicity could be avoided in patients with breast or hematological cancer treated with common cardiovascular medications.

The analysis, which examined more than 900 patients across 9 studies, revealed 1 in 10 cases of cardiotoxicity among patients with breast or hematological cancer could be avoided with use of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).

"Our study provides support for the routine use of beta-blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers in patients receiving cancer treatment but the decision should be made on a case by case basis," said investigator Sergio Moral, MD, PhD, of Hospital Universitari Josep Trueta and Hospital Santa Caterina in Spain, in a press release.

To evaluate whether chemotherapy cardiotoxicity could be prevented with use of ACE inhibitors, ARBs, or beta-blockers, investigators performed a systematic review and meta-analyses using data from all randomized studies evaluating this effect in the EMBASE, MEDLINE, and PsycINFO databases from January 2005 to April 2019. From this search, a total of 9 studies involving 913 participants were identified for inclusion in the current study.

Of the 913 participants included, 337 (33%) received beta-blockers, 152 received ACE inhibitors or ARBs, 45 received both beta-blockers and ARBs or ACE inhibitors, and the remaining 379 (41%) were used as controls. For the purpose of the present analyses, cardiotoxicity was defined as a drop in left ventricular ejection fraction below 50% or greater than 10% and/or clinical heart failure during the first year of follow-up.

Analyses revealed 118 (12%) of patients included in the study developed cardiotoxicity during the first year of follow-up. Additionally, investigators found patients who received the aforementioned treatments had a lower risk of developing cardiotoxicity than those in the control group (RR=0.381, IC 95%: 0.160-0.911, P=0.030, I2=63.2%).

Further analyses indicated a non-significant tendency for both treatments to exhibit a cardioprotective effect (Beta-blockers: RR=0.477, IC 95%: 0.178-1.275, P=0.140, I2=57.3%; ACE/ARBs: RR=0/283, IC 95%, 0.027-2.982, P=0.293, I2=79%). Investigators pointed out there was no difference between either treatment in studies comparing them and the estimated number of patients to be treated to avoid 1 case of cardiotoxicity was calculated to be 10 patients.

“Cardioprotective medications are not habitually prescribed in patients with cancer and our study suggests that they should be considered,” Moral added. “Cancer and cardiovascular disease share common risk factors which also influence susceptibility to cardiotoxicity.”

This abstract, titled “Cardioprotective effect of angiotensin converting enzyme inhibitors and beta-blockers in the primary prevention of cardiotoxicity: systematic review and meta-analysis of randomised studies,” was presented at EuroEcho 2019.