Review

. 2025 Dec 2;31(1):7.

doi: 10.1007/s10741-025-10575-2.

Pharmacological prevention in cardio-oncology: from bench-to-bedside

Ashot A Avagimyan¹, Nana Pogosova^{2

3}, Federica Fogacci⁴, Olga Urazova⁵, Zinaida Djndoyan⁶, Liliya Mirzoyan⁷, Gayane Avetisyan⁸, Marco Bernardi⁹, Luigi Spadafora⁹, Davood Shafie¹⁰, Francesco Perone¹¹, Marzieh Taheri¹², Arrigo Cicero^{4

13}, Giuseppe Biondi Zoccai^{9

14}, Riccardo Asteggiano¹⁵, Rosalinda Madonna¹⁶, Raffaele De Caterina¹⁷, Nizal Sarrafzadegan¹²

Affiliations

¹ Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan, 0025, Armenia. ashot.avagimyan@meduni.am.
² Deputy Director of Research and Preventive Cardiology, National Medical Research Centre of Cardiology, Moscow, 121552, Russia.
³ Head of Evidence Based Medicine Department, Peoples' Friendship University of Russia, Moscow, 117198, Russia.
⁴ Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, 40138, Italy.
⁵ Head of Pathophysiology Department, Siberian State Medical University, Tomsk, 634050, Russia.
⁶ Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan, 0025, Armenia.
⁷ Tambov State University after G. R. Derzhavin, Tambov, 392036, Russia.
⁸ Department of Topographic Anatomy and Operative Surgery, Yerevan State Medical University, Yerevan, 0025, Armenia.
⁹ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, 04100, Italy.
¹⁰ Heart Failure Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, 81583-88994, Iran.
¹¹ Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa Delle Magnolie", Castel Morrone, Caserta, 81020, Italy.
¹² Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
¹³ Cardiovascular Medicine Unit, Heart, Chest and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy.
¹⁴ Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Italy.
¹⁵ School of Medicine, University of Insubria, Varese, 21100, Italy.
¹⁶ Cardiology Division, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 56124, Italy. rosalinda.madonna@unipi.it.
¹⁷ Cardiology Division, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 56124, Italy.

PMID: 41326864
DOI: 10.1007/s10741-025-10575-2

Review

Pharmacological prevention in cardio-oncology: from bench-to-bedside

Ashot A Avagimyan et al. Heart Fail Rev. 2025.

. 2025 Dec 2;31(1):7.

doi: 10.1007/s10741-025-10575-2.

Authors

Affiliations

¹ Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan, 0025, Armenia. ashot.avagimyan@meduni.am.
² Deputy Director of Research and Preventive Cardiology, National Medical Research Centre of Cardiology, Moscow, 121552, Russia.
³ Head of Evidence Based Medicine Department, Peoples' Friendship University of Russia, Moscow, 117198, Russia.
⁴ Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, 40138, Italy.
⁵ Head of Pathophysiology Department, Siberian State Medical University, Tomsk, 634050, Russia.
⁶ Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan, 0025, Armenia.
⁷ Tambov State University after G. R. Derzhavin, Tambov, 392036, Russia.
⁸ Department of Topographic Anatomy and Operative Surgery, Yerevan State Medical University, Yerevan, 0025, Armenia.
⁹ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, 04100, Italy.
¹⁰ Heart Failure Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, 81583-88994, Iran.
¹¹ Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa Delle Magnolie", Castel Morrone, Caserta, 81020, Italy.
¹² Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
¹³ Cardiovascular Medicine Unit, Heart, Chest and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy.
¹⁴ Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Italy.
¹⁵ School of Medicine, University of Insubria, Varese, 21100, Italy.
¹⁶ Cardiology Division, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 56124, Italy. rosalinda.madonna@unipi.it.
¹⁷ Cardiology Division, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 56124, Italy.

PMID: 41326864
DOI: 10.1007/s10741-025-10575-2

Erratum in

Correction to: Pharmacological prevention in cardio-oncology: from bench-to-bedside.
Avagimyan AA, Pogosova N, Fogacci F, Urazova O, Djndoyan Z, Mirzoyan L, Avetisyan G, Bernardi M, Spadafora L, Shafie D, Perone F, Taheri M, Cicero A, Zoccai GB, Asteggiano R, Madonna R, De Caterina R, Sarrafzadegan N. Avagimyan AA, et al. Heart Fail Rev. 2026 Jan 20;31(1):20. doi: 10.1007/s10741-025-10590-3. Heart Fail Rev. 2026. PMID: 41557159 No abstract available.

Abstract

Recent advancements in oncology have markedly enhanced cancer survival rates; however, anticancer therapies, particularly anthracyclines, pose significant cardiovascular (CV) risks, collectively referred to as cancer therapy-related cardiovascular toxicity (CTR-CVT). This review consolidates evidence on strategies to mitigate CTR-CVT especially associated with anthracyclines. Neurohormonal blockers, including ACE inhibitors, ARBs, and β-blockers, constitute the foundation of prevention, although their efficacy varies: combinations such as ACEi/ARB with βB yield mixed outcomes, whereas carvedilol offers antioxidant benefits beyond β-blockade. Sacubitril/valsartan (ARNI) has demonstrated improvements in global longitudinal strain and LVEF preservation in the SARAH trial, albeit with associated hypotension risks. Aldosterone antagonists show potential, with spironolactone preserving LVEF and diastolic function, though eplerenone has not shown significant effects. Statins present conflicting data; the STOP-CA trial supports atorvastatin for LVEF preservation, while the PREVENT and SPARE-HF trials found no benefit. Emerging evidence suggests sodium-glucose cotransporter-2 inhibitors (SGLT2i), such as dapagliflozin and empagliflozin, as promising agents, with preclinical and early clinical data indicating cardioprotection through metabolic modulation, anti-inflammatory effects, and reduced oxidative stress. Gaps remain in understanding CTR-CVT pathophysiology, risk stratification, and the translation of preclinical findings. Future efforts should prioritize personalized approaches, dynamic risk assessment (e.g., HFA-ICOS tool), and a paradigm shift from oxidative stress to cardiometabolic dysfunction. Multidisciplinary collaboration is essential to optimize oncological outcomes while minimizing CV toxicity, with SGLT2i representing a key frontier for validation in ongoing trials.

Keywords: Cardio-oncology; Cardiotoxicity; Doxorubicin; Prevention.

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Conflict of interest statement

Declarations: Ashot Avagimyan, the first author of this submission, is part of his Dissertation for Doctor of Science (DSc) in Medicine. Ethical Compliance: No applicable. Competing interests: The authors declare no competing interests.

References

Reference list

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Pharmacological prevention in cardio-oncology: from bench-to-bedside

Affiliations

Pharmacological prevention in cardio-oncology: from bench-to-bedside

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

Reference list

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Medical

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