A new analysis suggests that angiotensin-converting enzyme (ACE) inhibitors may mitigate anthracycline-induced left ventricular dysfunction (AI-LVD) and cardiomyopathy. Findings of the analysis were published in the Clinical Journal of Oncology Nursing.

The analysis was a literature review of PubMed®, Scopus, Cochrane Library, and Ovid® databases for publications involving ACE inhibitors and anthracycline-induced cardiomyopathy, and it was conducted by Catherine Andrea Kobza, MSN, of Memorial Sloan Kettering Cancer Center in New York, New York. A total of 5 studies published between January 2010 and January 2020 met criteria for inclusion in the literature review.

Criteria included the use of ACE inhibitors was examined without being used in combination with other cardioprotective agents, left ventricular dysfunction was assessed before and after anthracycline treatment, and cardiac dysfunction was measured with echocardiography.

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Two studies were randomized, controlled trials (RCTs) in which enalapril was given to patients receiving combinations with doxorubicin vs no ACE inhibitor. One study was a prospective, observational study in which perindopril was administered to patients receiving epirubicin; control group participants did not receive an ACE inhibitor. The remaining 2 studies were meta-analyses.

In one of the RCTs, the use of an ACE inhibitor was not associated with prevention of AI-LVD. However, the other RCT showed no significant change in left ventricular ejection fraction (LVEF) after anthracycline treatment in patients who received an ACE inhibitor, whereas those who did not receive an ACE inhibitor experienced a significant loss of LVEF after anthracycline treatment. This report was similar to patterns seen in the prospective, observational study. The meta-analyses also suggested that ACE inhibitors may exert a cardioprotective effect.

These data show that ACE inhibitors may have efficacy against AI-LVD. “The search for methods to decrease the incidence of AI-LVD should be a priority for all cancer-related disciplines to help ensure that the survival benefit of cancer therapies is not compromised by increased mortality secondary to cardiac complications,” Ms Kobza concluded in her report.


Kobza CA. Cardiac toxicity: using angiotensin-converting enzyme inhibitors to prevent anthracycline-induced left ventricular dysfunction and cardiomyopathy. Clin J Oncol Nurs. 2021;25(3):259-266. doi:10.1188/21.CJON.259-266