Evidence map›Paper›PMID 37314568›Full record

SynthesisCardiovascular drugs and therapy2025

Comparing Renin-Angiotensin-Aldosterone Blockade Regimens for Long-Term Chemotherapy-Related Cardiac Dysfunction: A Network Meta-Analysis.

Jiaqi Li, Ainsley Ryan Yan Bin Lee, Areeba Tariq, Grace Lau, Chun En Yau, Li Ling Tan, Sara Moiz Tyebally, Matilda Xinwei Lee, Chieh Yang Koo, Ching-Hui Sia

Abstract readSystematic ReviewComparative StudyNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Cardiovascular drugs and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Review
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jiaqi Li *School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Ainsley Ryan Yan Bin Lee *Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Areeba TariqYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Grace LauYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Chun En YauYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Li Ling TanDepartment of Cardiology, National University Heart Center Singapore, Singapore, Singapore.
Sara Moiz TyeballyDepartment of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore.
Matilda Xinwei LeeDepartment of Hematology-Oncology, National University Cancer Institute Singapore, Singapore, Singapore.
Chieh Yang KooDepartment of Cardiology, National University Heart Center Singapore, Singapore, Singapore.
Ching-Hui SiaDepartment of Cardiology, National University Heart Center Singapore, Singapore, Singapore. ching_hui_sia@nuhs.edu.sg.ORCID 0000-0002-2764-2869

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCancer therapies including trastuzumab and anthracyclines are cardiotoxic and cause cardiac dysfunction. To prevent cardiotoxicity, pharmacological agents used in heart failure have been administered concomitantly with cardiotoxic cancer therapy, but few studies to date have performed a head-to-head comparison of these different agents. This systematic review and network meta-analysis of randomized-controlled trials aims to evaluate the efficacy of renin-angiotensin-aldosterone system (RAAS) blockers, namely angiotensin-converting enzyme inhibitors (ACE-Is), aldosterone receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), in primary prevention against chemotherapy-related cardiac dysfunction in patients receiving anthracyclines and/or trastuzumab.

methodsA systematic search was performed in major web databases for studies from inception to 15 September 2022. A Bayesian network meta-analysis model was used to assess the relative effects of competing treatments on the primary outcomes of risk of significant decline in left ventricular ejection fraction (LVEF) and mean LVEF decline. Secondary outcomes included left ventricular diastolic function, global longitudinal strain, and cardiac biomarkers. This study is registered with PROSPERO, CRD42022357980. RESULTS AND

conclusionNineteen studies reported the effects of 13 interventions (N = 1905 patients). Only enalapril (RR 0.05, 95% CI 0.00-0.20) was associated with reduced risk of patients developing significant decline in LVEF relative to placebo. Subgroup analysis showed that the beneficial effect of enalapril was driven by protection against anthracycline-associated toxicity. In addition, no RAAS-inhibiting agents showed efficacy in protection against treatment with both anthracycline and trastuzumab. The use of RAAS inhibition therapy did not conclusively impact on other markers of cardiac function, including left ventricular diastolic function and cardiac biomarkers.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnthracyclinesAntineoplastic AgentsMineralocorticoid Receptor AntagonistsRenin-Angiotensin SystemTrastuzumabVentricular Dysfunction, LeftVentricular Function, LeftCardiotoxicityHumansRandomized Controlled Trials as TopicRisk FactorsStroke VolumeTime FactorsTreatment OutcomeAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnthracyclinesAntineoplastic AgentsMineralocorticoid Receptor AntagonistsTrastuzumabAnthracyclinesCardiotoxicityChemotherapy-related cardiac dysfunctionLVEF dysfunctionTrastuzumab

Identifiers

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.