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Review
. 2025 Jun 4;12(6):212.
doi: 10.3390/jcdd12060212.

Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients

Luigi Spadafora  1   2 , Francesca Maria Di Muro  3 , Chiara Intonti  4 , Ludovica Massa  5 , Mauro Monelli  6 , Roberto Franco Enrico Pedretti  7   8 , Edvige Palazzo Adriano  6 , Pasquale Guarini  9   10 , Gaia Cantiello  1 , Marco Bernardi  1   2 , Federico Russo  11 , Stefano Cacciatore  12   13 , Pierre Sabouret  14 , Michele Golino  15 , Giuseppe Biondi Zoccai  1   16 , Francesca Romana Zimatore  17 , Laura Adelaide Dalla Vecchia  6
Affiliations
Review

Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients

Luigi Spadafora et al. J Cardiovasc Dev Dis. .

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.

Keywords: anthracycline-induced cardiotoxicity; anthracyclines; cardiac pre-habilitation; cardiac rehabilitation; cardio-oncology; exercise; pharmacological strategies; prevention.

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Conflict of interest statement

Giuseppe Biondi-Zoccai has consulted for Aleph, Amarin, Balmed, Cardionovum, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Menarini, Microport, Opsens Medical, Terumo, and Translumina, outside the present work. Pierre Sabouret reports consulting fees from Axis-TV, Astra-Zeneca, BMS, Les laboratoires Servier, Novartis, Menarini, Sanofi, outside the submitted work. No other authors report any conflict of interest.

Figures

Figure 1
Figure 1
Primary components of lifestyle interventions and their key mechanisms of action. Abbreviations. DNA: deoxyribonucleic acid; ROS: reactive oxygen species.
See this image and copyright information in PMC

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