{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:24Z","timestamp":1787008704870,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000288","name":"Royal Society","doi-asserted-by":"publisher","award":["107731\/Z\/15\/Z"],"award-info":[{"award-number":["107731\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/501100000288","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000288","name":"Royal Society","doi-asserted-by":"publisher","award":["220283\/Z\/20\/Z"],"award-info":[{"award-number":["220283\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/501100000288","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Advanced Fellowship","award":["NIHR301730"],"award-info":[{"award-number":["NIHR301730"]}]},{"name":"UK Department of Health and Social Care"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Evidence for the use of beta-blockers, angiotensin II receptor blockers (ARB), or angiotensin-converting enzyme inhibitors (ACEi) to mitigate chemotherapy-induced cardiotoxicity is inconclusive. The objectives are 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This cohort study used linked English electronic healthcare records from 9875 adult (\u226518 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. The 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% confidence interval (CI): 1.34\u20132.14], but further adjustment for gender, comorbidities, and other medications reduced the association to close to null (HR: 1.07, 95% CI: 0.68\u20131.69). There was no evidence that the association differed by cancer site, age, radiotherapy, prior cardiovascular disease, or years since cancer diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found no evidence that general practitioner 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeaf039","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T06:33:00Z","timestamp":1745476380000},"source":"Crossref","is-referenced-by-count":4,"title":["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"],"prefix":"10.1093","volume":"5","author":[{"given":"Pooja","family":"Hindocha","sequence":"first","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1A 7HT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R","family":"Lyon","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London and Cardio-Oncology Centre of Excellence, Royal Brompton Hospital , Sydney Street, London SW3 6NP ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5364-8757","authenticated-orcid":false,"given":"Krishnan","family":"Bhaskaran","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1A 7HT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8739-4601","authenticated-orcid":false,"given":"Helen","family":"Strongman","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1A 7HT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"2025062608330136500_oeaf039-B1","author":"Cancer Research UK"},{"key":"2025062608330136500_oeaf039-B2","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.jacc.2014.06.1167","article-title":"Prevention of anthracycline-induced cardiotoxicity","volume":"64","author":"Vejpongsa","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2025062608330136500_oeaf039-B3","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1111\/imj.12532","article-title":"Chemotherapy-related cardiomyopathy: a neglected aspect of cancer survivorship","volume":"44","author":"Nolan","year":"2014","journal-title":"Intern Med J"},{"key":"2025062608330136500_oeaf039-B4","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1186\/1471-2407-10-337","article-title":"Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials","volume":"10","author":"Smith","year":"2010","journal-title":"BMC Cancer"},{"key":"2025062608330136500_oeaf039-B5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3389\/fcvm.2020.00026","article-title":"Cardiotoxicity of anthracyclines","volume":"7","author":"Cardinale","year":"2020","journal-title":"Front Cardiovasc Med"},{"key":"2025062608330136500_oeaf039-B6","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1093\/jnci\/djs317","article-title":"Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study","volume":"104","author":"Bowles","year":"2012","journal-title":"J Natl Cancer Inst"},{"key":"2025062608330136500_oeaf039-B7","author":"Pfizer","year":"2014"},{"key":"2025062608330136500_oeaf039-B8","author":"European Medicines Agency (EMA)"},{"key":"2025062608330136500_oeaf039-B9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jaccao.2019.08.003","article-title":"Efficacy of dexrazoxane in preventing anthracycline cardiotoxicity in breast cancer","volume":"1","author":"Macedo","year":"2019","journal-title":"JACC CardioOncol"},{"key":"2025062608330136500_oeaf039-B10","first-page":"391","article-title":"2009 focused update incorporated into the ACC\/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation","volume":"119","author":"Hunt","year":"2009","journal-title":"Circulation"},{"key":"2025062608330136500_oeaf039-B11","doi-asserted-by":"publisher","first-page":"4229","DOI":"10.1093\/eurheartj\/ehad196","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur Heart J"},{"key":"2025062608330136500_oeaf039-B12","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.breast.2017.10.010","article-title":"Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy \u00b1 trastuzumab","volume":"37","author":"Gujral","year":"2018","journal-title":"Breast"},{"key":"2025062608330136500_oeaf039-B13","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data resource profile: Clinical Practice Research Datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int J Epidemiol"},{"key":"2025062608330136500_oeaf039-B14","author":"CPRD"},{"key":"2025062608330136500_oeaf039-B15","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0140-6736(19)31674-5","article-title":"Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases","volume":"394","author":"Strongman","year":"2019","journal-title":"Lancet Lond Engl"},{"key":"2025062608330136500_oeaf039-B16","doi-asserted-by":"publisher","DOI":"10.17037\/DATA.00001113","article-title":"Code lists used in \"Medium and long-term risks of specific cardiovascular diseases among 108,215 survivors of 20 adult cancers: population-based cohort study using multiple linked UK electronic health records databases\". [Project].","author":"Strongman","year":"2019","journal-title":"LSHTM Data Compass"},{"key":"2025062608330136500_oeaf039-B17","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1093\/ije\/dys188","article-title":"Data resource profile: cardiovascular disease research using linked bespoke studies and electronic health records (CALIBER)","volume":"41","author":"Denaxas","year":"2012","journal-title":"Int J Epidemiol"},{"key":"2025062608330136500_oeaf039-B18","author":"WHO\/Europe"},{"key":"2025062608330136500_oeaf039-B19","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1002\/sim.2655","article-title":"Analysing and interpreting competing risk data","volume":"26","author":"Pintilie","year":"2007","journal-title":"Stat Med"},{"key":"2025062608330136500_oeaf039-B20","doi-asserted-by":"crossref","first-page":"e1002457","DOI":"10.1371\/journal.pmed.1002457","article-title":"Lansoprazole use and tuberculosis incidence in the United Kingdom Clinical Practice Research Datalink: a population based cohort","volume":"14","author":"Yates","year":"2017","journal-title":"PLoS Med"},{"key":"2025062608330136500_oeaf039-B21","volume-title":"Stata Statistical Software: Release 16","author":"StataCorp","year":"2019"},{"key":"2025062608330136500_oeaf039-B22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s10654-018-0442-4","article-title":"Approach to record linkage of primary care data from Clinical Practice Research Datalink to other health-related patient data: overview and implications","volume":"34","author":"Padmanabhan","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"2025062608330136500_oeaf039-B23","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.1016\/j.ejca.2013.04.030","article-title":"Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: a systematic review and meta-analysis","volume":"49","author":"Kalam","year":"2013","journal-title":"Eur J Cancer"},{"key":"2025062608330136500_oeaf039-B24","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1136\/postgradmedj-2015-133535","article-title":"Cardioprotective role of \u03b2-blockers and angiotensin antagonists in early-onset anthracyclines-induced cardiotoxicity in adult patients: a systematic review and meta-analysis","volume":"91","author":"Yun","year":"2015","journal-title":"Postgrad Med J"},{"key":"2025062608330136500_oeaf039-B25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s40360-019-0298-6","article-title":"Beta-blockers for the primary prevention of anthracycline-induced cardiotoxicity: a meta-analysis of randomized controlled trials","volume":"20","author":"Ma","year":"2019","journal-title":"BMC Pharmacol Toxicol"},{"key":"2025062608330136500_oeaf039-B26","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1161\/CIRCHEARTFAILURE.112.000055","article-title":"Cardioprotective effect of \u03b2-adrenoceptor blockade in patients with breast cancer undergoing chemotherapy","volume":"6","author":"Seicean","year":"2013","journal-title":"Circ Heart Fail"},{"key":"2025062608330136500_oeaf039-B27","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1002\/ajh.21840","article-title":"Cardioprotective effect of metoprolol and enalapril in doxorubicin-treated lymphoma patients: a prospective, parallel-group, randomized, controlled study with 36-month follow-up","volume":"85","author":"Georgakopoulos","year":"2010","journal-title":"Am J Hematol"},{"key":"2025062608330136500_oeaf039-B28","doi-asserted-by":"crossref","first-page":"f2350","DOI":"10.1136\/bmj.f2350","article-title":"Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study","volume":"346","author":"Herrett","year":"2013","journal-title":"BMJ"},{"key":"2025062608330136500_oeaf039-B29","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S1388-9842(00)00131-8","article-title":"Incidence of newly diagnosed heart failure in UK general practice","volume":"3","author":"Johansson","year":"2001","journal-title":"Eur J Heart Fail"},{"key":"2025062608330136500_oeaf039-B30","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1002\/pds.883","article-title":"Approaches to combat with confounding by indication in observational studies of intended drug effects","volume":"12","author":"McMahon","year":"2003","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025062608330136500_oeaf039-B31","doi-asserted-by":"crossref","first-page":"3058","DOI":"10.1093\/annonc\/mds127","article-title":"Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis","volume":"23","author":"Tarantini","year":"2012","journal-title":"Ann Oncol"},{"key":"2025062608330136500_oeaf039-B32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1365-2125.2009.03537.x","article-title":"Validation and validity of diagnoses in the general practice research database: a systematic review","volume":"69","author":"Herrett","year":"2010","journal-title":"Br J Clin Pharmacol"},{"key":"2025062608330136500_oeaf039-B33","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/bja\/aet290","article-title":"Demystifying propensity scores","volume":"112","author":"Okoli","year":"2014","journal-title":"Br J Anaesth"}],"container-title":["European Heart Journal Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeaf039\/63011897\/oeaf039.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/5\/3\/oeaf039\/63011897\/oeaf039.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/5\/3\/oeaf039\/63011897\/oeaf039.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T08:33:12Z","timestamp":1750926792000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjopen\/article\/doi\/10.1093\/ehjopen\/oeaf039\/8120141"}},"subtitle":[],"editor":[{"given":"Joerg","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjopen\/oeaf039","relation":{},"ISSN":["2752-4191"],"issn-type":[{"value":"2752-4191","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,4,25]]},"article-number":"oeaf039"}}