Cardioprotective drugs and heart failure/cardiomyopathy incidence in chemotherapy-treated cancer survivors of breast cancer and non-Hodgkin lymphoma: A retrospective cohort study in England

Evidence for the use of beta-blockers, angiotensin II receptor blockers (ARBs) or angiotensin converting enzyme inhibitors (ACEis) to mitigate chemotherapy-induced cardiotoxicity is inconclusive.

To investigate associations between prescription of ARBs, ACEis and/or beta-blockers in the year following cancer diagnosis and subsequent risk of heart failure/cardiomyopathy (HF/CM) in chemotherapy-treated breast cancer and Non-Hodgkin Lymphoma (NHL) survivors.

This cohort study used linked English electronic healthcare records from 9,875 adult (≥18 years) breast cancer and NHL survivors who received chemotherapy. Cox Regression was used to estimate the association between primary care-prescribed beta-blocker, ARB and ACEi use in the year following cancer diagnosis, and subsequent HF/CM incidence, adjusting for potential confounders. Likelihood ratio tests were used to assess effect modification.

Mean follow-up duration was 4.9 years (maximum 21.4). After adjusting for age, the risk of HF/CM was higher in the exposed group (hazard ratio (HR): 1.69, 95% CI: 1.34-2.14). but further adjustment for gender, comorbidities and other medications reduced the association to close to null (HR: 1.07, 95% CI: 0.68-1.69). There was no evidence that the association differed by cancer site, age, radiotherapy, prior CVD disease or years since cancer diagnosis.

We found no evidence that GP-prescribed beta-blocker, ARB or ACEi use was associated with a reduced incidence of HF/CM in this population of chemotherapy-treated breast cancer and NHL survivors. This might be because the drug dosage and timing were not optimized to prevent chemotherapy-related cardiac damage; residual confounding by indication may also have obscured any treatment benefit.