Statin therapy reduces radiation-induced cardiotoxicity in patients with breast cancer receiving radiotherapy 

1. In a cohort of individuals with invasive ductal carcinoma (IDC) that underwent breast-conserving surgery (BCS) and adjuvant breast radiotherapy, the use of statins was associated with a decreased risk of major adverse cardiovascular events (MACE).

2. All statins were effective at reducing the risk of MACE; however, hydrophilic statins (specifically rosuvastatin and pravastatin) had the greatest positive effect. 

Evidence Rating Level: 2 (Good) 

Breast cancer is one of the most common types of cancers worldwide, including in Taiwan, where the incidence has increased in recent years. Radiation therapy is a new treatment that has therapeutic benefits for early-stage breast cancer after breast-conserving surgery (BCS). Although some positive effects are associated with this treatment, there is also evidence of cardiotoxicity effects varying based on radiation dose, systemic agents, and other risk factors for coronary heart disease in the patient. Previous preclinical studies have shown support for the cardioprotective benefits of statins; however, they have not been studied in this context or type of study before. Thus, the goal of this study was to understand the benefits of statin use and their ability to reduce major adverse cardiovascular event (MACE) risk in breast cancer patients undergoing BCS and radiotherapy. Patients were eligible to participate if they were 18 years or older, had a confirmed diagnosis of breast invasive ductal carcinoma (IDC), stage I disease with no metastasis, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Adjusted hazard ratios (aHRs) were calculated to examine the relationship between statin use and MACE risk. The study included 1481 patients diagnosed with left-sided stage I breast IDC. Among these patients, 1039 and 442 patients were assigned to the nonstatin and statin groups respectively. After performing propensity score matching (PSM), the incidence of MACE was significantly higher in the nonstatin group compared to the statin group (33.61% vs 20.28%, P<0.0001). In the statin group, the aHR for MACE was 0.34 (95% CI, 0.25-0.44, P<0.0001) compared to the nonstatin group. Different classes of statins were examined, and all of them showed a similar protective effect compared with not using statins. Hydrophilic statins, specifically rosuvastatin and pravastatin had the greatest risk reduction in MACE incidence. There was a statistically significant difference in the 5-year cumulative incidence of MACE between the statin group (12.24%) versus the nonstatin group (31.70%) (P<0.0001). There was a dose-response relationship between the risk of MACE and the use of statins, where higher cumulative defined daily doses (cDDD) were associated with a lower MACE risk. Overall, in adults with stage I breast IDC who underwent BCS and whole breast radiation therapy, statin use was associated with a decreased risk of MACE. 

Click to read the study in JAHA

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