Cardiotoxicity remains a major challenge in cancer care because cardiovascular complications can interrupt or even prevent completion of anticancer therapy, potentially compromising treatment outcomes. To what extent do guideline-recommended heart failure therapies protect cardiac function in patients receiving anticancer treatment? That question was addressed in a new meta-analysis presented at the European Society of Cardiology Congress (ESC 2026).

Explaining why the analysis was carried out, presenter Ymke Appels, researcher at Erasmus Medical Center, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, Netherlands, said, “ESC guidelines for cardio-oncology recommend using certain treatments in patients with cancer who show signs of cardiac dysfunction, 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.”

To address this evidence gap, researchers performed a meta-analysis to evaluate how effectively guideline-recommended heart failure therapies preserve cardiac function in patients receiving anticancer treatment.

The analysis involved systematically searching biomedical literature databases for studies of 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 and the 2023 update. Randomized controlled trials and retrospective and prospective nonrandomized 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 SGLT2 inhibitors. Statins were also considered.

In total, 49 studies were identified, which involved 6998 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 or standard of care (P < .001).

Over the 22 beta-blocker studies, there was a more modest LVEF improvement of 1.20% compared with placebo or standard of care (P = .05). Notably, across the eight studies involving a combination of RAAS inhibition and beta-blockers, LVEF improved by 2.98% (P < .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 placebo or standard of care, but these data were derived from only two studies. The one study with SGLT2 inhibition showed an LVEF improvement of 3.20%.

Statins were investigated in seven studies and showed an LVEF increase of 2.49% compared with placebo or standard of care (P < .001).

According to Wouter Meijers, MD, PhD, cardiologist in Rotterdam and the study’s 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 randomized trials, particularly of newer cardiovascular treatments, to fully understand their place in cardio-oncology.”

This story was translated from Medscape’s French edition.