Nutraceuticals for Preventing and Managing Cancer Chemotherapy-Induced Cardiotoxicity: An Updated Comprehensive Review.

Chemotherapy-induced cardiotoxicity remains a major barrier to durable cancer control and survivor well-being, arising from oxidative stress, mitochondrial injury, inflammation, and emerging pyroptotic pathways. This updated narrative review integrates mechanistic and clinical data on nutraceuticals, including amino acids, fatty acids, vitamins, minerals, and polyphenols. Consistent clinical signals include omega-3 fatty acids, alpha-lipoic acid, vitamin D, coenzyme Q10, black seed oil, and vitamin E with levocarnitine, which primarily reduce oxidative stress to protect against cardiotoxicity. Additional preclinical and early clinical work highlights vitamin C-, taurine-, zingerone-, and rosemary-derived phenolics as candidates that target oxidative and inflammatory injury without compromising antitumor activity. Translation to care should be prevention-focused, pairing baseline risk assessment with surveillance that utilizes high-sensitivity troponin, natriuretic peptides, and advanced echocardiography, such as global longitudinal strain. Nutraceuticals should complement rather than replace established oncologic therapy and cardioprotection, with integration guided by individual risk and ongoing monitoring.