Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients
Luigi Spadafora, Francesca Maria Di Muro, Chiara Intonti, Ludovica Massa, Mauro Monelli, Roberto F.E. Pedretti, Edvige Palazzo Adriano, Pasquale Guarini, Gaia Cantiello, Marco Bernardi, Federico Russo, Stefano Cacciatore, Pierre Sabouret, Michele Golino, Giuseppe Biondi‐Zoccai, Francesca Romana Zimatore, Laura Adelaide Dalla Vecchia
Abstract
Anthracyclines remain a cornerstone of cancer therapy but are associated with a significant risk of cardiotoxicity, which can lead to overt heart failure. The risk is modulated by cumulative dose, pre-existing cardiovascular disease, and patient-specific factors. As cancer survival improves, the long-term cardiovascular consequences of anthracycline exposure have become a growing concern, underscoring the need for effective preventive strategies. This narrative review examines lifestyle and pharmacological interventions aimed at mitigating anthracycline-induced cardiotoxicity. Evidence suggests that structured exercise programs and antioxidant-rich diets may enhance cardiovascular resilience, while beta-blockers, renin-angiotensin system inhibitors, and dexrazoxane remain central pharmacological options. Emerging therapies, including sodium-glucose co-transporter 2 inhibitors and sacubitril/valsartan, show promise but require further investigation. A comprehensive approach that integrates lifestyle modifications with pharmacological strategies within a multidisciplinary cardio-oncology framework may provide optimal protection, improving long-term cardiovascular outcomes in cancer patients receiving anthracyclines.