Anthracycline-induced cardiotoxicity – primary preventive options. An overview

Abstract

Anthracycline-induced cardiotoxicity (AIC) has been known since the 1970s but remains relevant, mainly due to the widespread use of anthracyclines in oncological practice. Currently, AIC is viewed as a prolonged and continuous process that starts with the initial dose at molecular and cellular levels and advances, ultimately resulting in cardiomyopathy and heart failure. Many contemporary studies aim to discover methods for early detection of anthracycline-related myocardial injury. Additionally, ongoing research focuses on agents for primary prevention of AIC, examining their effectiveness, place, and timing of administration. This review aims to present the available preventive options, interconnecting them with their mechanisms of action and the mechanisms of AIC. According to current recommendations, primary prevention is indicated for high- and very high-risk patients and includes general measures to lower cardiovascular risk, neurohormonal therapy, and statins. Regular cardiology assessments are a crucial component of heart damage prevention. Evidence of mild myocardial injury (deteriorated Global Longitudinal Strain and troponin release) justifi es cardioprotective measures. Some aspects remain unanswered, including whether early cardioprotection is required, as well as the role and effi cacy of sacubitril/valsartan and sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) for AIC prevention. Physical activity is a promising method to reduce the cardiac damaging effects of anthracyclines. 

Keywords

• anthracyclines
• cardiotoxicity
• cardioprotection