Potential role of angiotensin-converting enzyme inhibitors vs beta-blockers in preventing anticancer agents-induced cardiotoxicity: A systematic review and meta-analysis

BACKGROUND Anthracyclines cause dose-dependent, irreversible cardiac dysfunction, whereas trastuzumab leads to dose-independent, reversible cardiotoxicity. Both beta-blockers and angiotensin-converting enzyme inhibitor (ACEI) have shown protective effect against anti-cancer agents-induced cardiotoxicity, however to date there is no head-to head comparison. Our metanalysis focuses on bridging this gap. AIM To compare the efficacy of ACEI and beta-blockers in preventing cardiotoxicity and to evaluate whether either class offers superior cardio-protection. METHODS PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials comparing beta-blockers with ACEI in patients of chemotherapy. 4 studies including 680 patients were analyzed using Revman random-effects model, and results were generated in form of relative risk and mean difference (MD). RESULTS There was no difference in the two groups in regards to: Change in E/E’ [MD = -0.25; 95% confidence interval (CI): -0.50 to 0.01; P = 0.06], change of left ventricular (LV) ejection fraction (MD = 0.38%; 95%CI: -0.35 to 1.11; P = 0.31), cardiotoxicity (MD = 1.07; 95%CI: 0.66-1.75, P = 0.77), change in LV end diastolic diameter (MD = -0.41%; 95%CI: -0.98 to 0.16; P = 0.16), change in LV end systolic diameter (MD = -0.20%; 95%CI: -0.70 to 0.30; P = 0.43) and change in E/A (MD = -0.01; 95%CI: -0.25 to 0.23; P = 0.92). While risk of total adverse events and palpitation were same in two groups, hypotension (11% vs 3%, P = 0.004) and dizziness (13% vs 6%, P = 0.01) were more frequent with ACEI. CONCLUSION Our study demonstrates that both groups offer similar protection against cardiotoxicity, with ACEI associated with more side-effects. Therefore, choice of agent should be guided by individual tolerability and clinical context.