Meta-Analysis Comparing Usefulness of Beta Blockers to Preserve Left Ventricular Function During Anthracycline Therapy

Shah, Priyank; Garris, Rana; Abboud, Rachel; Vasudev, Rahul; Patel, Hiten; Doshi, Rajkumar; Shamoon, Fayez; Bikkina, Mahesh

doi:10.1016/j.amjcard.2019.05.046

Cited by 19 publications

(11 citation statements)

References 27 publications

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“…On the other hand, no significant haemodynamic consequence of the eplerenone treatment could be seen in the animals at the applied dose (6.25 mg/kg). Previously, several smaller clinical trials [31-34, 57, 58, 66] and some meta-analyses [67][68][69][70] have investigated the prophylactic effects of BBs and ACEIs applied alone or in combination to prevent AC cardiotoxicity, however, their results were not always consistent. Although some study groups demonstrated the protective effects of the applied agent on the LV EF [31,33,34,66], others could not confirm the superiority of the study drug compared to placebo [32,57,58].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic, single-drug cardioprotection in a comparative, experimental study of doxorubicin-induced cardiomyopathy

et al. 2020

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Background Cardiomyopathy is a common side effect of doxorubicin (DOX) chemotherapy. Despite intensive research efforts in the field, there is still no evidence available for routine cardioprotective prophylaxis to prevent cardiotoxicity in the majority of oncological patients at low risk of cardiovascular disease. We have recently demonstrated the advantages of a prophylactic, combined heart failure therapy in an experimental model of DOX-induced cardiomyopathy. In the current work, we focus on individually applied prophylactic medications studied in the same translational environment to clarify their distinct roles in the prevention of DOX cardiotoxicity. Methods Twelve-week-old male Wistar rats were divided into 5 subgroups. Prophylactic β-blocker (BB, bisoprolol), angiotensin-converting enzyme inhibitor (ACEI, perindopril) or aldosterone antagonist (AA, eplerenone) treatments were applied 1 week before DOX administration, then 6 cycles of intravenous DOX chemotherapy were administered. Rats receiving only intravenous DOX or saline served as positive and negative controls. Blood pressure, heart rate, body weight, and echocardiographic parameters were monitored in vivo. Two months after the last DOX administration, the animals were sacrificed, and their heart and serum samples were frozen in liquid nitrogen for histological, mechanical, and biochemical measurements. Results All prophylactic treatments increased the survival of DOX-receiving animals. The lowest mortality rates were seen in the BB and ACEI groups. The left ventricular ejection fraction was only preserved in the BB group. The DOX-induced increase in the isovolumetric relaxation time could not be prevented by any prophylactic treatment. A decreased number of apoptotic nuclei and a preserved myocardial ultrastructure were found in all groups receiving prophylactic cardioprotection, while the DOX-induced fibrotic remodelling and the increase in caspase-3 levels could only be substantially prevented by the BB and ACEI treatments. Conclusion Primary prophylaxis with cardioprotective agents like BB or ACEI has a key role in the prevention of DOX-induced cardiotoxicity in healthy rats. Future human studies are necessary to implement this finding in the clinical management of oncological patients free of cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 99%

Prophylactic, single-drug cardioprotection in a comparative, experimental study of doxorubicin-induced cardiomyopathy

et al. 2020

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“…For site-specific cancers, the focus was mainly on the role of BBs in breast cancer. Through systematic review and metaanalysis of published literature, it was confirmed that BBs could significantly reduce the risk of mortality (Childers et al, 2015), recurrence (Zhao et al, 2018), and cardiotoxicity treated with anthracyclines in breast cancer (Shah et al, 2019). There are also relevant studies showing that BBs have no significant relationship with breast cancer survival, recurrence, and other aspects (Kim et al, 2017).…”

Section: Anti-hypertensive Drugs Have the Potential To Become Adjuvanmentioning

confidence: 92%

The Relationship Between Anti-Hypertensive Drugs and Cancer: Anxiety to be Resolved in Urgent

et al. 2020

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Hypertension is the prevailing independent risk factor for cardiovascular disease worldwide. Anti-hypertensive drugs are the common and effective cure for lowering blood pressure in patients with hypertension. However, some large-scale clinical studies have pointed out that long-term ingestion of some oral anti-hypertensive drugs was associated with risks of incident cancer and the survival time. In contrast, other studies argue that anti-hypertensive drugs are not related to the occurrence of cancer, even as a complementary therapy of tumor treatment. To resolve the dispute, numerous recent mechanistic studies using animal models have tried to find the causal link between cancer and different anti-hypertensive drugs. However, the results were often contradictory. Such uncertainties have taken a toll on hypertensive patients. In this review, we will summarize advances of longitudinal studies in the association between anti-hypertensive drugs and related tumor risks that have helped to move the field forward from associative to causative conclusions, in hope of providing a reference for more rigorous and evidence-based clinical research on the topic to guide the clinical decision making.

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“…For example, in anthracycline-based chemotherapy regimens, beta-blockers confer a protective effect. 81 In CYC, doxorubicin, vincristine and prednisolone-based chemotherapy for non-Hodgkin’s lymphoma, the addition of valsartan prevents development of acute cardiotoxicity. 82 The Canadian Cardiovascular Society recommends the use of cardiovascular agents for primary prevention in patients at high risk of chemotherapeutic agent-driven cardiac dysfunction.…”

Section: Potential Measures To Reduce Cardiac Toxicity During Ahsctmentioning

confidence: 99%

Cardiotoxicity in autologous haematopoietic stem cell transplantation for systemic sclerosis

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et al. 2023

Journal of Scleroderma and Related Disorders

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Autologous haematopoietic stem cell transplantation is now well-established as an effective treatment for severe systemic sclerosis with clear demonstration of favourable end-organ and survival outcomes. Treatment-related cardiotoxicity remains the predominant safety concern and contraindicates autologous haematopoietic stem cell transplantation in patients with severe cardiopulmonary disease. In this review, we describe the cardiovascular outcomes of autologous haematopoietic stem cell transplantation recipients, discuss the potential mechanisms of cardiotoxicity and propose future mitigating strategies.

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Meta-Analysis Comparing Usefulness of Beta Blockers to Preserve Left Ventricular Function During Anthracycline Therapy

Cited by 19 publications

References 27 publications

Prophylactic, single-drug cardioprotection in a comparative, experimental study of doxorubicin-induced cardiomyopathy

Prophylactic, single-drug cardioprotection in a comparative, experimental study of doxorubicin-induced cardiomyopathy

The Relationship Between Anti-Hypertensive Drugs and Cancer: Anxiety to be Resolved in Urgent

Cardiotoxicity in autologous haematopoietic stem cell transplantation for systemic sclerosis

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