Statin Exposure and Risk for HF Hospitalization in Women Treated With Anthracycline

Women treated with anthracyclines for breast cancer and exposed to statins were found to be at reduced risk for heart failure (HF) hospitalization, according to a study published in the Journal of the American Heart Association.

In this retrospective cohort study, data from the Canadian Institute of Health Information’s Discharge Abstract Database, the National Ambulatory Care Reporting, and the Ontario Drug Benefit database were examined. These databases collect data on hospitalizations, emergency department visits, and dispensed drugs, respectively. Women aged ³66 years who received anthracyclines (n=2545) or trastuzumab (n=1371) between 2007 and 2017 within 1 year of an early breast cancer diagnosis were included. Clinical outcomes and previous drug exposures were assessed.

Of patients treated with anthracycline and trastuzumab, 859 and 520 had previously been exposed to statins, respectively. Women exposed to statins were significantly older (P <.001) and had higher instances of pre-existing cardiovascular disease and associated risk factors (P £.01 for all) with the exception of left-sided disease  and atrial fibrillation in patients treated with trastuzumab.

After propensity matching, pairs of patients receiving/not receiving statins and treated with anthracycline (n=666) or trastuzumab (n=390) were selected. Among the propensity-matched anthracycline cohort, 46.4% received rosuvastatin, 40.8% atorvastatin, 7.7% simvastatin, and 4.1% pravastatin.

After a mean follow-up of 5.1±3.1 years, 43 hospitalizations for HF occurred. The incidence of hospitalization for HF was lower in patients treated vs not treated with statins (cumulative incidence: 1.2%; 95% CI, 0.5%-2.6% vs 2.9%; 95% CI, 1.7%-4.6%, respectively; cause-specific hazard ratio [HR], 0.45; 95% CI, 0.24-0.85; P =.01).

Among the propensity-matched trastuzumab cohort, 46.7% received rosuvastatin, 41.3% atorvastatin, and 8.0% simvastatin.

After a mean follow-up of 4.4±2.8 years, 27 hospitalizations for HF occurred. The risk for HF hospitalizations was comparable in women taking vs not taking statins (cumulative incidence: 2.7%; 95% CI, 1.2%-5.2% vs 3.7%; 95% CI, 2.0%-6.2%, respectively; cause-specific HR, 0.46; 95% CI, 0.20-1.07; P =.07).

In a sensitivity analysis, in which data from women with evidence of acute myocardial infarction was not taken into account, women exposed vs unexposed to statins remained at lower risk for HF hospitalization in the anthracycline cohort (HR, 0.44; 95% CI, 0.22-0.87; P .02), a difference which reached significance in the trastuzumab cohort (HR, 0.41; 95% CI, 0.17-0.97; P =.04).

Study limitations include the use of data from administrative databases, and the fact that left ventricle ejection fraction, diastolic function, biohumoral characteristics, or cardiac biomarkers were not taken into account.

“Our findings provide further support for definitive randomized controlled trials on this topic,” concluded the study authors. “The current data can inform the design and power calculations of such trials to determine whether pre-treatment with statins is effective at preventing HF after anthracyclines or trastuzumab.” Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Abdel-Qadir H, Bobrowski D, Zhou L, et al. Statin Exposure and Risk of Heart Failure After Anthracycline- or Trastuzumab-Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study. J Am Heart Assoc. 2021;e018393. doi:10.1161/JAHA.119.018393