2024Heart failurePrevention111 patients

PROACT

Therapy group: Cardio-oncology · Therapy: Enalapril

In breast cancer or lymphoma patients receiving high-dose anthracyclines, enalapril did not significantly reduce troponin-defined myocardial injury compared with standard care.

Published in JACC CardioOncol (2024)

Question: Can enalapril, added to standard care, prevent cardiotoxicity (myocardial injury and impaired cardiac function) in patients receiving high-dose anthracycline-based chemotherapy?
Design: Prospective, multicenter, randomized, open-label, superiority trial with observer-blinded endpoints. A total of 111 participants were randomized.
Population: Patients with breast cancer or non-Hodgkin lymphoma scheduled for 6 cycles of chemotherapy with a planned dose of at least 300 mg/m2 doxorubicin equivalents.
Intervention: Enalapril titrated up to 20 mg daily, in addition to standard care during chemotherapy.
Control: Standard care without enalapril.
Primary outcome: Myocardial injury defined by cardiac troponin T ≥14 ng/L during chemotherapy and 1 month after its completion.
Results: Myocardial injury by troponin T occurred in 42 of 54 patients (77.8%) on enalapril vs 45 of 54 (83.3%) on standard care (OR 0.65; 95% CI 0.23-1.78). By troponin I (>26.2 ng/L), injury occurred in 47.2% with enalapril vs 45.3% with standard care (OR 1.10; 95% CI 0.50-2.38).
Conclusion: Adding enalapril to standard care during chemotherapy did not prevent cardiotoxicity in patients receiving high-dose anthracycline-based chemotherapy.
Why it matters: It provided evidence that routine enalapril does not protect against anthracycline-induced cardiac injury, prompting reconsideration of its preventive use in this population.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 14, 2026

Sources

Original publication on PubMed (PMID 39479329) ↗Preventing Cardiac Damage in Patients Treated for Breast Cancer and Lymphoma: The PROACT Clinical Trial.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT03265574) ↗

Videos explaining it

Cardio-Oncology Spotlight: The PROACT Trial and Reflections on Cardio-Protection Trials, Dr. Davi...

IC-OS · International Cardio-Oncology Society ↗4:21Video page

Source: International Cardio-Oncology Society · YouTube
Date: 2 Jun 2025
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: Unconfirmed · check ⚙YouTube

All videos explaining it · 2 videos

4:21

Cardio-Oncology Spotlight: The PROACT Trial and Reflections on Cardio-Protection Trials, Dr. Davi...

Source: International Cardio-Oncology Society · YouTube
Date: 2 Jun 2025
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: Unconfirmed · check ⚙YouTube

15:15

PROACT Study: Apixaban versus Warfarin in patients with mechanical heart valves #46

Source: SOCESP - Sociedade de Cardiologia do Estado de SP · YouTube
Date: 7 Nov 2023
Audio: Portuguese
Subtitles: MultilingualYouTube
Audio transl.: None

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