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 European Society of Cardiology (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 β-blockers as preventive medications in high-risk patients. Clinical trials have shown ambiguous results for ACE-I/ARBs and β-blockers in reducing cardiotoxicity, while co-administration of ACE-I/ARBs and β-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.