Statins may mitigate anthracycline, trastuzumab cardiotoxicity risk
medwireNews: Statin use is associated with a reduced risk for heart failure in women with early breast cancer receiving anthracycline- or trastuzumab-based chemotherapy, report Canadian researchers.
They drew on linked administrative data to identify all women in Ontario, Canada, aged at least 66 years who had no history of heart failure and received anthracyclines and/or trastuzumab within a year of being diagnosed with early-stage breast cancer between 2007 and 2017.
The team then used propensity scores to match 666 anthracycline-treated and 390 trastuzumab-treated women who filled at least two statin prescriptions in the 365 days prior to the initiation of anticancer treatment with the same number of their non-statin-using counterparts. The most common statins used in each cohort were rosuvastatin and atorvastatin, at around 46% and 41%, respectively.
During an average follow-up of 5.1 years in the anthracycline cohort, the cumulative incidence at 5 years of hospitalization or emergency department visits due to heart failure was 1.2% among statin users and 2.9% for nonusers, equating to a significant hazard ratio (HR) of 0.45 in favor of statins.
Similarly, the 5-year cumulative incidence of heart failure hospital presentations in the trastuzumab cohort (mean follow-up, 4.4 years) was lower for women who did versus did not take statins, at 2.7% and 3.7%, respectively, but the HR of 0.46 did not reach statistical significance.
“This analysis was limited by low event counts, with trastuzumab-associated cardiotoxicity less likely to lead to decompensated [heart failure] requiring hospitalization or [emergency department] visits,” write Husam Abdel-Qadir (Women’s College Hospital, Toronto, Ontario) and colleagues.
“However, our data suggest that this area merits further study,” they add in the Journal of the American Heart Association.
The findings were similar in sensitivity analyses censoring women with an interim hospitalization for acute myocardial infarction and adjusting for low-density lipoprotein values, say the study authors.
But they urge caution in interpreting the study results “given its retrospective design and dependence on administrative data,” and also highlight the inability to “exclude that the lower risk of [heart failure] in statin-exposed patients may represent residual confounding.”
Nonetheless, Abdel-Qadir et al believe that “[t]hese findings support the development of randomized controlled trials of statins for prevention of cardiotoxicity.”
And they conclude: “Statin use should be encouraged in women with established indications who are starting potentially cardiotoxic chemotherapy for early breast cancer.”
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