Pharmacological strategies to prevent cancer therapy-related cardiovascular toxicity: the road to personalised cardioprotection

Cancer therapy-related cardiovascular toxicity is an increasingly recognised challenge in modern oncology, as life-saving treatments can lead to significant cardiac complications. This review explores the current landscape of medical strategies aimed at preventing cardiotoxicity across a broad range of cancer therapies. High-risk patients are identified based on clinical and treatment-related risk factors, necessitating proactive risk stratification. Neurohormonal blockade strategies have shown promising although not universally consistent effects against therapy-induced cardiovascular toxicity. As well, lipid-lowering agents may offer additional cardiovascular protection through both lipid modulation and anti-inflammatory properties. Moreover, emerging evidence supports the potential of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in mitigating cardiotoxic effects, calling for dedicated clinical trials. In the meantime, the 2022 European Society of Cardiology guidelines provided a structured approach to integrating pharmacological and non-pharmacological protective strategies in cardio-oncology. Challenges remain in standardising care due to heterogeneous data and limited large-scale trials. Multidisciplinary collaboration, ongoing translational research and personalised medicine are crucial to optimising cardiovascular outcomes in patients with cancer.