血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂和β肾上腺素能阻滞剂在蒽环类药物和曲妥珠单抗诱导的心脏毒性中的预防作用。

The Preventive Role of Angiotensin Converting Enzyme Inhibitors/Angiotensin-II Receptor Blockers and β-Adrenergic Blockers in Anthracycline- and Trastuzumab-Induced Cardiotoxicity.

机构信息

From the Department of Medicine Icahn School of Medicine at Mount Sinai, New York, NY.

Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.

出版信息

Cardiol Rev. 2019 Sep/Oct;27(5):256-259. doi: 10.1097/CRD.0000000000000252.

Abstract

Anthracycline (doxorubicin) and trastuzumab treatments for cancer patients have been known to cause cardiotoxicity. The current recommendations for prevention of cardiac events from cancer chemotherapies are largely based on opinion. The American Society of Clinical Oncology recommends active screening and prevention of modifiable cardiovascular risk factors. The risk factors are defined as tobacco use, high blood pressure, high cholesterol, alcohol use, obesity, and physical inactivity. Beta-adrenergic blockers and angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) have been the mainstay of treatment for heart failure patients with reduced left ventricular ejection fraction for many years. This review analyzed the use of beta-adrenergic blockers and ACE inhibitors/ARBs as protection against cardiomyopathy caused by anthracyclines and trastuzumab. Although many more studies are warranted, it was concluded that the addition of a beta-blocker early in the treatment of cancer patients who are undergoing anthracycline or trastuzumab treatment can have beneficial effects in preserving left ventricular ejection fraction and preventing chemotherapy-induced cardiotoxicity. The effects are more apparent in the short term. More studies of the long-term effects are warranted, as are the additive effects of using a beta-blocker and ACE inhibitor/ARB together to prevent chemotherapy-induced cardiotoxicity.

摘要

蒽环类药物(多柔比星)和曲妥珠单抗治疗癌症患者已知会导致心脏毒性。目前预防癌症化疗引起心脏事件的建议主要基于意见。美国临床肿瘤学会建议积极筛查和预防可改变的心血管危险因素。这些危险因素定义为吸烟、高血压、高胆固醇、饮酒、肥胖和缺乏身体活动。多年来,β肾上腺素阻滞剂和血管紧张素转换酶(ACE)抑制剂/血管紧张素受体阻滞剂(ARB)一直是治疗左心室射血分数降低的心力衰竭患者的主要方法。这篇综述分析了β肾上腺素阻滞剂和 ACE 抑制剂/ARB 作为预防蒽环类药物和曲妥珠单抗引起的心肌病的作用。尽管还需要更多的研究,但结论是,在接受蒽环类药物或曲妥珠单抗治疗的癌症患者的治疗早期添加β受体阻滞剂可以对保留左心室射血分数和预防化疗引起的心脏毒性产生有益的影响。这些影响在短期内更为明显。需要更多的研究来观察长期效果,以及同时使用β受体阻滞剂和 ACE 抑制剂/ARB 来预防化疗引起的心脏毒性的附加效果。

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