Statins may help prevent left ventricular dysfunction in patients treated with anthracycline therapy, according to a study in the International Journal of Cardiology.
Researchers conducted a meta-analysis of randomized controlled trials (RCTs) that assessed the effect of statins on cardiotoxicity in cancer survivors treated with anthracyclines.
A search of relevant studies was performed in PubMed and Scopus from inception until May 3, 2023. Eligible studies were RCTs and included patients with any type of cancer who received anthracyclines as a chemotherapeutic agent and used statin therapy during cancer treatment. Muscle pain and serious adverse events were safety endpoints.
The analysis included 5 studies with 808 patients (401 in the statin-treated group and 407 in the placebo group), and the median follow-up was 10 months.
Patients who received statins had a decreased incidence of cardiotoxicity vs those who received placebo (risk ratio [RR], 0.52; 95% CI, 0.33-0.83; P =.01; I2 = 0%). No significant difference in hospitalization for heart failure was observed between the groups during the follow-up (RR, 0.71; 95% CI, 0.26-1.93; P =.50; I2 = 0%).
The statin-treated group had a greater mean left ventricular ejection fraction (LVEF) after anthracycline therapy (mean difference [MD], 1.88; 95% CI, 0.66-3.1; P <.01; I2 = 57.3%). The statin group also had a more favorable change in LVEF (∆LVEF), with a P value near significance (MD, 2.38; 95% CI, -0.03 to 4.79; P =.05; I2 = 99%). Severe heterogeneity was observed in the pooled analyses for LVEF and ∆LVEF.
No significant difference in safety endpoints was found between the statin-treated group and the control group (RR, 1.31 [95% CI, 0.78-2.20; P =.3; I2 = 0%], and RR, 0.79 [95% CI, 0.37-1.67; P =.53; I2 = 0%], respectively).
Meta-regression analysis showed a positive association between the magnitude of the statin-related protective effect and the cumulative dosage of anthracycline therapy for ∆LVEF and final LVEF (both P <.01).
Limitations of the study include variation in the definition of cardiotoxicity among the 5 included RCTs, and the pooled analysis is underpowered to detect significant differences in clinical endpoints and safety endpoints. In addition, cancer therapy-related cardiac dysfunction (CTRCD) is not uniform, and the included RCTs differed regarding study design, tumor type, cumulative anthracycline dose, imaging method, and follow-up duration.
“Statins represent a promise in mitigating CTRCD,” the researchers wrote. “Undoubtedly, larger RCTs with adequate follow-up are required to evaluate the impact of statins alone or in combination with the most recent guided-directed medical therapy (ie, sodium-glucose cotransporter 2 inhibitors) on prognosis in patients receiving anthracyclines therapy.”
Disclosure: One of the study authors declared an affiliation with a medical device company. Please see the original reference for a full list of authors’ disclosures.
D’Amario D, Laborante R, Bianchini E, et al. Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials. Int J Cardiol. Published online July 30, 2023. doi: 10.1016/j.ijcard.2023.131219