随着肿瘤治疗的进展，乳腺癌的五年生存率接近90%。化疗引起的心血管毒性已成为影响乳腺癌患者生存的重要因素。蒽环类抗癌药物，如多柔比星，仍然是一些最有效的化疗药物，但其产生的心脏毒性通常被认为是逐渐进行性和不可逆转的。除了蒽环类药物外，铂类和烷基类抗肿瘤药物也表现出一定的心脏毒性作用。靶向药物一直被认为是相对安全的选择。然而，近年来一些随机临床试验观察到靶向抗肿瘤药物使用者出现亚临床心脏毒性的发生，这可能与靶向药物对血管紧张素转化酶、血管紧张素受体和β受体的影响有关。使用血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体拮抗剂和β受体阻滞剂可能可以预防临床心脏毒性。本文综述了当前临床抗乳腺癌药物的毒性和机制，并提出预防心血管毒性的策略，为化疗相关心肌病的临床预防和治疗提供建议。© 2023版权归Elsevier Masson SAS所有。

With the progression of tumor treatment, the 5-year survival rate of breast cancer is close to 90%. Cardiovascular toxicity caused by chemotherapy has become a vital factor affecting the survival of patients with breast cancer. Anthracyclines, such as doxorubicin, are still some of the most effective chemotherapeutic agents, but their resulting cardiotoxicity is generally considered to be progressive and irreversible. In addition to anthracyclines, platinum- and alkyl-based antitumor drugs also demonstrate certain cardiotoxic effects. Targeted drugs have always been considered a relatively safe option. However, in recent years, some random clinical trials have observed the occurrence of subclinical cardiotoxicity in targeted antitumor drug users, which may be related to the effects of targeted drugs on the angiotensin converting enzyme, angiotensin receptor and β receptor. The use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and beta-blockers may prevent clinical cardiotoxicity. This article reviews the toxicity and mechanisms of current clinical anti-breast cancer drugs and proposes strategies for preventing cardiovascular toxicity to provide recommendations for the clinical prevention and treatment of chemotherapy-related cardiomyopathy.Copyright © 2023. Published by Elsevier Masson SAS.