Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Cardiol. Jun 26, 2026; 18(6): 120930
Published online Jun 26, 2026. doi: 10.4330/wjc.120930
Potential role of angiotensin-converting enzyme inhibitors vs beta-blockers in preventing anticancer agents-induced cardiotoxicity: A systematic review and meta-analysis
Manjeet Singh, Samar Mehdi, Madihah Alam, Vyom Patel, Rohan Patel, Simran Patel, Shahryar Chaudhry, Azeem Khan, Zaraq Khan, Haider Hussain Shah, Ridda Khattak, Rohab Sohail
Rohab Sohail, Ridda Khattak, Azeem Khan, Shahryar Chaudhry, Simran Patel, Rohan Patel, Madihah Alam, Samar Mehdi, Department of Internal Medicine, Bayhealth Medical Center, Dover, DE 19904, United States
Haider Hussain Shah, Department of Medicine, Bayhealth Hospital, Kent Campus, Dover, DE 19901, United States
Zaraq Khan, Department of Internal Medicine, Indiana University School of Medicine, Southwest Internal Medicine Residency Program, Evansville, IN 46202, United States
Vyom Patel, Department of Internal Medicine, Indiana University School of Medicine, Evansville, IN 47591, United States
Manjeet Singh, Department of Cardiology and Cardiovascular Diseases, Bayhealth Medical Center, Dover, DE 19904, United States
Author contributions: Sohail R, Khattak R, Hussain Shah H, Khan Z, Khan A, Chaudhry S, Patel S, Patel R, Patel V, Alam M, and Mehdi S worked on writing-original draft; Sohail R conceptualized the study, designed the methodology, performed formal analysis and software operation, and prepared the original manuscript draft; Sohail R Khattak R, and Shah H validated the research concept; Sohail R and Singh M reviewed and edited the manuscript; Shah H undertook project administration; Singh M supervised the overall study; and all authors reviewed and approved the final submitted version.
AI contribution statement: ChatGPT was used for language polishing, translation, and writing assistance of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Rohab Sohail, MD, Department of Internal Medicine, Bayhealth Medical Center, 640 South State Street, Dover, DE 19904, United States.
rohabsohail98@gmail.com
Received: March 12, 2026
Revised: April 13, 2026
Accepted: June 2, 2026
Published online: June 26, 2026
Processing time: 99 Days and 9.9 Hours
BACKGROUND
Anthracyclines cause dose-dependent, irreversible cardiac dysfunction, whereas trastuzumab leads to dose-independent, reversible cardiotoxicity. Both beta-blockers and angiotensin-converting enzyme inhibitor (ACEI) have shown protective effect against anti-cancer agents-induced cardiotoxicity, however to date there is no head-to head comparison. Our metanalysis focuses on bridging this gap.
AIM
To compare the efficacy of ACEI and beta-blockers in preventing cardiotoxicity and to evaluate whether either class offers superior cardio-protection.
METHODS
PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials comparing beta-blockers with ACEI in patients of chemotherapy. 4 studies including 680 patients were analyzed using Revman random-effects model, and results were generated in form of relative risk and mean difference (MD).
RESULTS
There was no difference in the two groups in regards to: Change in E/E’ [MD = -0.25; 95% confidence interval (CI): -0.50 to 0.01; P = 0.06], change of left ventricular (LV) ejection fraction (MD = 0.38%; 95%CI: -0.35 to 1.11; P = 0.31), cardiotoxicity (MD = 1.07; 95%CI: 0.66-1.75, P = 0.77), change in LV end diastolic diameter (MD = -0.41%; 95%CI: -0.98 to 0.16;P = 0.16), change in LV end systolic diameter (MD = -0.20%; 95%CI: -0.70 to 0.30; P = 0.43) and change in E/A (MD = -0.01; 95%CI: -0.25 to 0.23; P = 0.92). While risk of total adverse events and palpitation were same in two groups, hypotension (11% vs 3%, P = 0.004) and dizziness (13% vs 6%, P = 0.01) were more frequent with ACEI.
CONCLUSION
Our study demonstrates that both groups offer similar protection against cardiotoxicity, with ACEI associated with more side-effects. Therefore, choice of agent should be guided by individual tolerability and clinical context.
Core Tip: This meta-analysis compared angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers for the prevention of anti-cancer agents-induced cardiotoxicity. Across randomized controlled trials, both drug classes showed similar effectiveness in preserving left ventricular ejection fraction and preventing overall, early, and late cardiotoxicity. Overall adverse event rates were similar between groups; however, hypotension and dizziness occurred more frequently with ACEI therapy. These findings suggest that ACEI and beta-blockers provide comparable cardioprotective benefit. Choice of therapy should therefore be individualized based on patient characteristics, blood pressure profile, and tolerability. Larger, adequately powered trials with longer follow-up are needed to determine whether meaningful differences between these strategies emerge over time.
