Statins Found to Reduce Anthracycline-Related Heart Dysfunction

According to study findings presented at the American College of Cardiology 2023 Scientific Session, patients receiving chemotherapy regimens containing anthracyclines for lymphoma were significantly less likely to show evidence of heart dysfunction when also taking atorvastatin for 1 year.

Anthracyclines are the most common chemotherapy in the treatment of lymphoma and are also used in several other cancer types. Investigators have had limited success in reducing the risk of cardiac toxicity with this drug class, however.

Heart damage is a common adverse effect (AE) associated with anthracycline treatment and can lead to heart dysfunction and failure. Results from the new trial suggest that statins can help lessen the effects of this cardiac damage, particularly in patients at an elevated risk due to older age, higher body mass index, or taking higher doses of anthracyclines.

“We believe that patients with lymphoma who are treated with anthracyclines and are at high risk of cardiac dysfunction and heart failure would benefit from statin therapy,” said co-lead author Marielle Scherrer-Crosbie, MD, a professor of medicine at the Hospital of the University of Pennsylvania, in a press release. “I think it’s an impactful study that will lead to more prescription of statins in patients.”

In the trial, called STOP-CA, investigators enrolled 300 patients with lymphoma undergoing treatment with anthracyclines at a median dose of 300 mg/m2. Half were assigned to take 40 mg of atorvastatin while the other half took a placebo daily, starting before their first dose of anthracyclines and continuing for 1 year. Patients’ left ventricle ejection fraction (LVEF) was assessed at baseline at 1 year and a total of 286 patients completed the study.

The primary endpoint was the proportion of patients who experienced a decline in LVEF of 10% or more (to less than 55%, near the lower limit of normal LVEF) from baseline to 1 year. This degree of reduction occurred in just 9% of those taking atorvastatin, whereas patients taking the placebo were nearly 3 times as likely (22%) to see this level of decline.

The trial’s secondary endpoint was a reduction in LVEF of 5% or more to less than 55% from baseline to 1 year. It was also significant in favor of atorvastatin.

“This effect will also need to be confirmed in terms of symptomatic heart failure, but the endpoint we chose is clinically relevant because those rates of decline in LVEF are associated with later symptomatic heart failure,” Scherrer-Crosbie said in the press release. “There is a clear protective effect of atorvastatin in terms of cardiac dysfunction in patients with lymphoma treated with anthracyclines.”

The results showed no significant difference in the rates of AEs such as muscle pain or renal failure.

At 1 year, patients who took statins had an average ejection fraction that was 1.3% higher than those who took placebo. This difference was statistically significant, although the researchers said it is not a large enough magnitude to be clinically relevant when viewed across the entire patient population, though the difference may be greater among subgroups of patients. This finding underscores the importance of identifying and treating populations that might benefit most from statin use.

More research is needed to elucidate which subgroups of patients may benefit most from statin use and examine whether statin therapy prevents symptomatic heart failure. The investigators also noted that the current study excluded those with below-normal LVEF at baseline and those with an indication for statins, meaning the population of patients included likely had better overall health than the general population of people with lymphoma.

REFERENCE

Statins show benefits in reducing heart dysfunction from anthracyclines. News release. American College of Cardiology. March 4, 2023. Accessed March 9, 2023.