The following is the summary of “Association of Neurohormonal Antagonists on Incident Cardiotoxicity in Patients With Breast Cancer” published in the February 2023 issue of Cardiovascular Disease by Umadat, et al.
Among people who have survived breast cancer, cardiovascular disease is the major cause of death. Patients receiving anthracyclines or trastuzumab should be monitored closely for the development of clinical heart failure or asymptomatic left ventricular systolic dysfunction due to the increased risk of cardiotoxicity. Preventing chemotherapy-induced cardiomyopathy in this population by blocking neurohormones with angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), or β-blockers is an open question.
Baseline characteristics, oncologic treatment, and outcomes were analyzed for 459 women diagnosed with breast cancer at our medical facility between January 2014 and December 2021. The major outcome measure was the incidence of cardiotoxicity, which was defined as a decrease in ejection fraction of 5% below 55% or an asymptomatic decline of 10% following chemotherapy treatment. Neurohormonal antagonists increased the prevalence of hypertension, hyperlipidemia, and diabetes in patients. Patients who were older (hazard ratio [HR] 1.04, 95% CI 1.01 to 1.1), current or former smokers (HR 2.54, 95% CI 1.41 to 4.6), or those who got trastuzumab and anthracycline therapy together were more likely to experience cardiotoxicity.
However, patients who took either ACE-I/ARBs (HR 0.49, 95% CI 0.17 to 1.4), beta-blockers (HR 0.50, 95% CI 0.16 to 1.6), or both (HR 1.30, 95% CI 0.44 to 3.9) did not experience any meaningful protective benefits over a median follow-up of 12 months. In conclusion, patients who had previously used ACE-I/ARBs and/or β-blockers before receiving anthracycline or trastuzumab treatments did not experience less cardiotoxicity. Factors identified as increasing vulnerability were advanced age, tobacco use, and treatment with combination chemotherapy.