Conventional and nonconventional therapies for pesticide-induced cardiotoxicity: A systematic review

Pesticides, as pervasive environmental pollutants, have been associated with cardiotoxic effects. However, evidence regarding cardioprotective strategies remains fragmented, particularly concerning the integration of conventional therapies and nonconventional approaches involving natural products. This systematic review (PROSPERO:CRD420251143191) aimed to synthesize experimental evidence on cardioprotection against pesticides, with emphasis on natural product-based interventions. The review was conducted according to PRISMA, with searches performed in Medline/PubMed, EMBASE, and BVS. Eligible studies included in vitro and in vivo models of pesticide exposure that reported cardiovascular outcomes and therapeutic interventions. A total of 85 studies were included, predominantly involving in vivo models. While only a few studies evaluated conventional antidotes, such as atropine and pralidoxime, most investigated natural and bioactive compounds, including antioxidant vitamins, polyphenols, flavonoids, carotenoids, and microbiota-modulating agents. Frequently studied compounds included vitamin E, vitamin C, lycopene, coenzyme Q10, resveratrol, and curcumin. Overall, these interventions demonstrated protective effects through attenuation of lipid peroxidation, restoration of endogenous antioxidant defenses, and modulation of inflammatory and apoptotic pathways. Studies also reported improvements in hemodynamic and electrocardiographic parameters. Collectively, these findings provide promising preclinical evidence that novel interventions may mitigate pesticide-induced cardiotoxicity, although they should be interpreted with caution due to the predominantly preclinical nature of the studies. © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/