STOP-CA Trial: Statin Therapy Associated With Reduced Heart Dysfunction From Anthracyclines

Patients receiving chemotherapy regimens containing anthracyclines for lymphoma were significantly less likely to show evidence of heart dysfunction after taking atorvastatin for 12 months, according to research from the STOP-CA trial, a multicenter, randomized, double-blind, placebo-controlled study presented at ACC.23/WCC.

Tomas G. Neilan, MD, MPH, FACC, et al., enrolled 300 patients (median age 52 years, 47% female) with lymphoma undergoing treatment with anthracyclines at a median dose of 300 mg/m2. The baseline left ventricular ejection fraction (LVEF) was 63% across the cohort. Half of the participants were randomized to take atorvastatin (40 mg) and half to take a placebo daily, starting before their first dose of anthracyclines and continuing for 12 months. A total 286 patients (95%) completed the study.

Researchers defined the primary endpoint as the proportion in each group who had a decline in LVEF of ≥10% to an EF <55%. The primary endpoint at 12 months occurred in 9% of the atorvastatin group and 22% in the placebo group (p=0.002), indicating that odds of experiencing the primary outcome was almost three-times greater for patients taking the placebo.

A secondary outcome concerning the proportion in each group who had a decline in LVEF of ≥5% to an EF <55% was additionally explored, with an incidence of 13% in the atorvastatin group and 29% in the placebo group (p=0.001). The results showed no significant difference in the rates of adverse events including muscle pain, elevated AST/ALT, myositis or renal failure.

The researchers noted that more research is needed to determine the subgroups who would benefit most from statin therapy, whether statin therapy prevents symptomatic HF, the optimal timing and duration of statin therapy during cancer treatment and whether this benefit extends to other types of cancers.

"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 the co-primary investigator Marielle Scherrer-Crosbie, MD, PhD, FACC. "I think it's an impactful study that will lead to more prescription of statins in patients."

Clinical Topics: Cardio-Oncology, Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: ACC Annual Scientific Session, ACC23, Anthracyclines, Cardiotoxicity, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Antibiotics, Antineoplastic, Polyketides, ACC.23/WCC Meeting Newspaper, ACC Scientific Session Newspaper

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