Meta-Analysis Confirms Heart Failure Drugs Protect Cardiac Function During Cancer Therapy
Key Insights
A meta-analysis of 49 studies involving 6,998 patients confirms that guideline-recommended heart failure therapies preserve left ventricular ejection fraction during anticancer treatment.
The combination of RAAS inhibitors (search) and beta-blockers (search) demonstrated the most robust cardioprotection, improving LVEF by 2.98% compared with placebo or standard of care (p<0.001).
Newer heart failure agents, including mineralocorticoid antagonists and SGLT2 inhibitors (search), showed promising signals but were evaluated in very few studies, underscoring the need for further randomized trials.
A comprehensive meta-analysis presented today at ESC Cardio-Oncology 2026 in Vienna has provided the strongest evidence to date that standard heart failure medications can protect cardiac function in patients undergoing cancer treatment. Researchers from Erasmus University Medical Centre (search) in Rotterdam pooled data from 49 studies encompassing 6,998 patients, confirming that therapies recommended in ESC heart failure guidelines significantly mitigate declines in left ventricular ejection fraction (LVEF) associated with anticancer drugs.
The analysis addresses a persistent clinical dilemma: cancer patients who develop cardiac side effects from their treatment may be forced to discontinue or reduce life-saving anticancer therapy, compromising oncologic outcomes. Current ESC cardio-oncology guidelines recommend specific heart failure treatments for patients exhibiting signs of cardiac dysfunction, yet the evidence underpinning these recommendations has been limited.
"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," said presenter Ms Ymke Appels. "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."
RAAS inhibitors (search) and beta-blockers (search) lead the evidence
The meta-analysis systematically searched biomedical literature databases for randomized controlled trials as well as retrospective and prospective non-randomised studies evaluating therapies from the 2021 ESC Guidelines for acute and chronic heart failure and the 2023 update. Drug classes assessed included renin-angiotensin-aldosterone system (RAAS) inhibitors — encompassing angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and angiotensin receptor neprilysin inhibitors — beta-blockers (search), mineralocorticoid receptor antagonists (search), sodium-glucose cotransporter-2 (SGLT2) inhibitors, and statins (search).
Across 23 studies assessing RAAS inhibition, LVEF improved by 2.88% compared with placebo or standard of care (p<0.001). Beta-blockers (search), evaluated in 22 studies, produced a more modest LVEF improvement of 1.20% (p=0.05). The combination of RAAS inhibition and beta-blockers, assessed in eight studies, yielded an LVEF improvement of 2.98% (p<0.001) — the most robust signal among the well-studied strategies.
Significant positive changes in global longitudinal strain, a sensitive marker of cardiac contraction, were also observed with RAAS inhibitors (search), beta-blockers (search), and the combination of both drug classes.
Emerging signals from newer agents
Mineralocorticoid receptor antagonists (search) demonstrated the largest numerical LVEF improvement at 4.68% compared with controls, but these data were derived from only two studies, limiting the strength of the conclusion. A single study of SGLT2 inhibition showed an LVEF improvement of 3.20%. Statins (search), investigated across seven studies, produced an LVEF increase of 2.49% compared with controls (p<0.001).
"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," concluded Doctor Wouter Meijers, Principal Investigator.
The findings reinforce the clinical rationale for early cardioprotective intervention in cancer patients receiving cardiotoxic therapies while simultaneously exposing significant evidence gaps for newer heart failure drug classes that have transformed cardiovascular care in recent years.