Anthracycline-induced cardiotoxicity prevention with angiotensin-converting enzyme inhibitor ramipril in low-risk breast cancer women: results of a prospective randomized study.

Anthracycline-induced cardiotoxicity (AIC) remains the main long-term and irreversible side effect in malignancy survivors. Cardiotoxicity prevention is one of most reasonable attitudes.
To verify whether ramipril is able to protect from early-onset AIC in prospective randomized open-label study.
Women with breast cancer (BC) were randomized to ramipril (RA) or control arm (CA). Data from 96 women, median age 47 years, without significant cardiovascular diseases, post-breast surgery and eligible for adjuvant anthracyclines, was analyzed. Cardiotoxicity was estimated with repeated echocardiography, troponin I and NT-proBNP levels over one-year follow-up. AIC was defined as a decrease in left ventricular ejection fraction (LVEF) and/or biomarkers elevation and/or occurrence of heart failure (HF) or cardiac death.
LVEF decrease ˃10 percent points occurred in 6.3% in RA vs 18.5% in controls (P = 0.15). No cases of HF, cardiac death or LVEF decline below ˂50% were reported. Percentage of patients with NT-proBNP elevation increased with time in CA (P = 0.003), whereas it remained unchanged in RA. At the end of observation, more patients in CA showed NTproBNP increase and fewer NT-proBNP decline (P = 0.01). No significant difference in troponin levels was found between the study arms. Ramipril was well tolerated in normotensive women.
In relatively young BC women without serious co-morbidities, who underwent anthracycline therapy, one year treatment with ramipril exerts potentially protective effect on the cardiotoxicty assessed with NT-proBNP, however its efficacy in long-term follow-up needs further investigations.