# Cardioprotective medications and the incidence of cardiovascular events in patients treated with radiotherapy: a systematic review and meta-analysis

## TL;DR

This study reviews how cardioprotective medications affect cardiovascular events in patients receiving radiotherapy, finding some benefits for stroke risk but limited evidence overall.

## Contribution

The study provides a meta-analysis of cardioprotective medication use in radiotherapy patients, highlighting gaps in guideline adherence.

## Key findings

- Statin therapy reduced cerebrovascular event risk in radiotherapy patients.
- No significant effect of statins on major adverse cardiac events was found.
- Many radiotherapy patients not on statins had indications for their use.

## Abstract

The purpose of this systematic review and meta-analysis is to explore the utilization of cardioprotective medications in patients treated with RT and assess their impact on cardiovascular and cerebrovascular events.

A literature search of PubMed, Embase and Scopus was performed in March 2025. Studies of adult patients treated with RT to the head and neck or thoracic regions which investigated the effects of cardioprotective medications (defined as anti-hypertensives, lipid-lowering therapies or anti-thrombotic medications) on the incidence of cardiovascular or cerebrovascular events were eligible for inclusion. Studies that reported the proportion of patients treated with RT who were utilizing cardioprotective medications as recommended by CVD guidelines were also included. Meta-analysis was performed using R with a random effects model.

There were 10 retrospective studies which were eligible for inclusion. Five of the ten studies included patients with head and neck cancer only, whilst two studies included patients with lung cancer and one study included patients with breast cancer alone. Meta-analysis of three studies suggested that patients treated with RT who received statin therapy had a reduced risk of cerebrovascular events (stroke or transient ischemic attack), with a relative risk of 0.74 (95% CI 0.60-0.90). There was no difference in major adverse cardiac events (MACE) for patients treated with RT to the head and neck or thoracic regions who received statin therapy compared to those who did not (relative risk 0.99, 95% CI 0.67 to 1.46, n = 5 studies). A meta-analysis of four studies suggested that 59% (95% CI 35% to 80%) of patients treated with RT not on statin therapy had indications for commencement of these medications.

Current evidence exploring the impact of cardioprotective medications on CVD risk in patients treated with RT is heterogenous and limited to retrospective non-randomized studies. A considerable proportion of patients undergoing RT are not being prescribed cardioprotective medications as suggested by existing CVD guidelines.

The online version contains supplementary material available at 10.1186/s40959-025-00439-x.