Pharmacological prevention methods in patients with cardiovascular disease with breast cancer – when, how, and for whom?

Breast cancer is the leading cause of cancer-related deaths in women worldwide. Patients with breast cancer are at an increased risk of cardiovascular toxicity, presently defined as cancer therapy-related cardiovascular toxicity (CTR-CVT). This article provides a summary of the current knowledge on pharmacological cardiovascular prevention in breast cancer patients. The ESC guidelines on cardio-oncology have defined CTR-CVT. Baseline risk stratification with widely accepted risk scores is essential to identify patients at higher risk of CTR-CVT. The guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), and beta-blockers as preventive medications in high-risk patients. Clinical trials have shown ambiguous results for ACE-I/ARBs and beta-blockers in reducing cardiotoxicity, while co-administration of ACE-I/ARBs and beta-blockers did not show additional benefits in preventing cardiac dysfunction. Further research is needed to verify the efficacy of novel cardioprotective medication and optimize pharmacological strategies for cardiovascular prevention in breast cancer patients.