New evidence on therapies that protect the heart from anticancer drugs

Key takeaways

• Heart failure treatments are recommended for patients who experience cardiac side effects of anticancer drugs, but this is based on limited evidence.
• When data from published studies were analysed together, the greatest improvement in cardiac function was found with RAAS inhibition and beta-blockers, two commonly used classes of heart failure treatments.
• Only a few studies assessed the protective effects of newer heart failure agents.
• This analysis highlights the need for further randomised trials to help guide the treatment of patients suffering from the double threat of cancer and cardiac dysfunction.
  

Vienna, Austria - 19 June 2026: The cardioprotective effects of heart failure treatments in patients with cancer were demonstrated today in a presentation at ESC Cardio-Oncology 2026, [1] the annual conference of the European Society of Cardiology's Council of Cardio-Oncology.

Patients receiving cancer treatment often face the added complication of side effects affecting the heart, which can lead to the need to discontinue anticancer therapy, reducing its effectiveness. Researchers from the Erasmus University Medical Centre, Rotterdam, The Netherlands, today presented their findings on the protective effects of medical therapies recommended to treat heart failure.

Explaining why the analysis was carried out, presenter Ms Ymke Appels said: "ESC Guidelines for cardio-oncology recommend using certain treatments in patients with cancer who show signs of cardiac dysfunction, [2] but the evidence for this comes largely from small studies, from expert opinion, and/or by adapting other guidelines such as those on heart failure. We conducted a meta-analysis of data from published studies to better understand how much different heart failure-recommended therapies prevent cardiac deterioration in patients treated with anticancer drugs."

The analysis involved systematically searching biomedical literature databases for studies in patients treated with anticancer drugs that evaluated the effects of therapies recommended in the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [3] and the 2023 update. [4] Randomised controlled trials and retrospective and prospective non-randomised studies were included. The drug classes assessed were renin-angiotensin-aldosterone system (RAAS) inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and angiotensin receptor neprilysin inhibitors), beta-blockers, mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors. Statins were also considered.

In total, 49 studies were identified, which involved 6,998 patients.

The analysis mainly investigated the effects of the different therapies on left ventricular ejection fraction (LVEF), a measure of the heart's pumping ability. Across 23 studies assessing RAAS inhibition, LVEF improved by 2.88% compared with placebo/standard of care (p<0.001). Over the 22 beta-blocker studies, there was a more modest LVEF improvement of 1.20% compared with placebo/standard of care (p=0.05). Notably, across the eight studies involving a combination of RAAS inhibition and beta-blockers, LVEF improved by 2.98% (p<0.001). Significant positive changes in global longitudinal strain, a marker of cardiac contraction, were also seen with RAAS inhibitors, beta-blockers and the combination of the two treatments.

Mineralocorticoid antagonists appeared to show encouraging protective effects, with an LVEF increase of 4.68% compared with controls, but these data were derived from only two studies. The one study with sodium-glucose cotransporter-2 inhibition showed an LVEF improvement of 3.20%.

Statins were investigated in seven studies and showed an LVEF increase of 2.49% compared with controls (p<0.001).

Doctor Wouter Meijers, Principal Investigator, concluded: "By pooling together study results, we have confirmed that guideline-recommended heart failure therapies - particularly a combination of RAAS inhibitors plus beta-blockers - protect heart function in patients being treated for cancer. The number of studies with other heart failure therapies was low, highlighting the need for further randomised trials, particularly of newer cardiovascular treatments, to fully understand their place in cardio-oncology."

ENDS