{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T08:12:58Z","timestamp":1763885578505,"version":"3.45.0"},"reference-count":34,"publisher":"King Faisal Specialist Hospital and Research Centre","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Saudi Med"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES AND DESIGN:<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES:<\/jats:title>\n                    <jats:p>The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SAMPLE SIZE:<\/jats:title>\n                    <jats:p>Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18\u201312.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>QUALITY OF EVIDENCE:<\/jats:title>\n                    <jats:p>Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger's regression test indicated a low risk of publication bias for LVEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>HETEROGENEITY:<\/jats:title>\n                    <jats:p>High (I\u00b2=97%) for LVEF at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LIMITATIONS:<\/jats:title>\n                    <jats:p>The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>PROSPERO CRD42024555546.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5144\/0256-4947.2025.421","type":"journal-article","created":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T08:09:23Z","timestamp":1763885363000},"page":"421-434","source":"Crossref","is-referenced-by-count":0,"title":["Angiotensin converting enzyme inhibitors (ACEIs) for anthracycline-induced cardiotoxicity: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.5144","volume":"45","author":[{"given":"Moaz","family":"Safwan","sequence":"first","affiliation":[{"name":"From the Department of Basic Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Al Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam Safwan","family":"Bourgleh","sequence":"additional","affiliation":[{"name":"From the Department of Basic Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Al Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hani","family":"AlShakaki","sequence":"additional","affiliation":[{"name":"From the Department of Basic Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Al Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3181-777X","authenticated-orcid":true,"given":"Khawaja Husnain","family":"Haider","sequence":"additional","affiliation":[{"name":"From the Department of Basic Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Al Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3134","reference":[{"key":"e_1_3_1_2_2","volume-title":"Anthracyclines","author":"Venkatesh P","year":"2023","unstructured":"Venkatesh P. 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