Cardiovascular disease is the leading cause of morbidity and mortality in the elderly. Managing cardiovascular risk in this group is uniquely challenging due to physiological changes, multimorbidity, polypharmacy, and frailty, compounded by the under-representation of older adults in clinical trials Recent advances, including the SCORE2-OP risk stratification tool and emerging therapies such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, have reshaped approaches to risk reduction. This review synthesizes the latest evidence and guideline recommendations for the management of hypertension, dyslipidaemia, diabetes, obesity, and antithrombotic therapy in older patients, with particular attention to frailty, adherence challenges, and individualized care. By addressing the complexities of cardiovascular risk management in older adults, this paper provides a practical framework for clinicians navigating this critical area.
G. Dacquino, G. Galati, Luca Genovese et al.· European Journal of Preventi...· 0 citations
Anthracyclines remain a cornerstone of systemic anticancer therapy but are limited by their well-recognized cardiotoxic potential, which may manifest as cancer therapy–related cardiac dysfunction (CTRCD). Despite increasing emphasis on preventive strategies in cardio-oncology, robust evidence supporting pharmacological cardioprotection is scarce. Sacubitril/valsartan has demonstrated clear benefits in heart failure populations; however, its preventive role in patients exposed to anthracyclines has not been systematically evaluated.
We performed a systematic review and meta-analysis of randomized controlled trials assessing sacubitril/valsartan for the prevention of CTRCD in adult patients treated with anthracycline-based chemotherapy (PROSPERO CRD420261278068). PubMed, Embase, Scopus, and the Cochrane Library were searched through December 2025. The primary outcome was CTRCD, defined according to 2022 ESC cardio-oncology guidelines. Secondary outcomes included changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and symptomatic hypotension. Random-effects models were used as the primary analytical approach.
Three randomized trials including 352 patients (mean age 52 ± 9 years; 94% breast cancer) were included. Sacubitril/valsartan was associated with a numerically lower risk of CTRCD that did not reach statistical significance in the random-effects model (RR 0.69, 95% CI 0.38–1.23; p=0.21), while the fixed-effects model showed a significant association favoring sacubitril/valsartan. Directionally favorable but non-significant trends were observed for LVEF and GLS. Sacubitril/valsartan was associated with a higher risk of symptomatic hypotension (RR 4.10, 95% CI 1.46–11.54).
This meta-analysis identifies a consistent, hypothesis-generating signal suggesting that sacubitril/valsartan may reduce CTRCD incidence and favorably influence cardiac imaging parameters in anthracycline-treated patients, at the cost of increased symptomatic hypotension. Larger, adequately powered trials are needed to define its role in cardio-oncology prevention strategies.
M. Camilli, L. Spadafora· European Heart Journal, Supp...· 0 citations
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