Statins may lower the risk of heart failure associated with anthracycline-based chemotherapy

1. In early breast cancer, exposure to statins during anthracycline-based chemotherapy was associated with a significantly lower risk of heart failure after 5 years.

2. Statin use during trastuzumab-based chemotherapy was associated with a non-significantly lower risk.

Evidence Rating Level: 2 (Good)

Early breast cancer (EBC) treatment often involves the use of anthracyclines and/or trastuzumab as chemotherapy. However, these treatments carry a risk of cardiotoxicity and therefore contribute to heart failure (HF), which may explain why heart disease is a leading cause of death for survivors of EBC. From some previous studies, statins have been identified as potential cardioprotective agents for these EBC treatments. The aim of the current retrospective cohort study was to investigate the association of HF risk and statin exposure in elderly EBC survivors who were treated with anthracyclines and/or trastuzumab. The study population consisted statin-exposed and unexposed women, matched 1:1 with propensity scores. This resulted in 666 pairs in the anthracycline cohort and 390 pairs in the trastuzumab cohort, and an overall median age of 69 (interquartile range 67-73 years). Individuals were considered statin-exposed if they were dispensed 2 statin prescriptions in the year before the date of the first anthracycline or trastuzumab treatment (index date), and with 1 prescription overlapping with the index date. For the anthracycline cohort, the study found the cumulative incidence of HF presentations at 5 years to be significantly different, at 1.2% (95% CI 0.5-2.6%) and 2.9% (95% CI 1.7-4.6%) in statin-exposed and unexposed patients respectively (p = 0.01). As well, the cause-specific hazard ratio for statins was 0.45 (95% CI 0.24-0.85, p = 0.01). For patients taking trastuzumab, the 5-year cumulative incidence was 2.7% (95% CI 1.2-5.2%) and 3.7% (95% CI 2.0-6.2%) for statin-exposed and unexposed respectively (p = 0.09), and the cause-specific HR for statins was 0.46 (95% CI 0.20-1.07, p = 0.07). Overall, this study demonstrated that statins are a potential cardioprotective agent for anthracycline-based EBC chemotherapy, with implications for further exploration through randomized controlled trials.

Click to read the study in JAHA

Image: PD

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