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Statins and Heart Failure Risk After Chemotherapy for Breast Cancer
Quick Takes
- Women ages >65 years with early breast cancer receiving anthracyclines who were on statin therapy had a lower incidence of heart failure compared to those who were not previously on statins.
- This large study corroborates findings from earlier, smaller studies. It is, however, limited by its observational nature and reliance on administrative data.
- Nevertheless, statin therapy should not be shied away from in this patient population given its potential benefit and overall low risk.
Study Questions:
Is the use of statins in women with breast cancer receiving anthracyclines or trastuzumab associated with a lower incidence of heart failure (HF)?
Methods:
In a propensity-matched case-control study using administrative databases from Ontario, Canada including the Ontario Drug Benefit program and the Ontario Cancer Registry, the authors sought to assess whether statin use in women aged >65 years with early breast cancer is associated with a lower risk of heart failure post-exposure to trastuzumab or anthracycline. Statin exposure was defined as the dispensing of ≥2 statin prescriptions prior to exposure to cardiotoxic therapies. Women with prior heart failure were excluded. Statin-exposed and unexposed women were matched 1:1 using propensity score matching, for which logistic regression model included demographics, cardiovascular risk factors, atherosclerotic disease, and the Charlson score. The primary outcome was a composite of hospitalizations or emergency department visits for HF. Death was treated as a competing risk.
Results:
The authors matched 666 statin-discordant pairs of anthracycline-treated women and 390 pairs of trastuzumab-treated women (median age, 69 and 71 years, respectively). The most commonly used statins in both groups were rosuvastatin (~40%) and atorvastatin (~40%). There were 43 HF hospitalizations in the anthracycline group and 27 HF hospitalizations in the trastuzumab group. The statin-exposed anthracycline cohort had a significantly lower 5-year cumulative incidence of HF hospitalization compared to the nonexposed group (1.2%; 95% confidence interval [CI], 0.5%–2.6% vs. 2.9%; 95% CI, 1.7%–4.6%), with a hazard ratio of 0.45 (95% CI, 0.24–0.85). The difference in cumulative incidence of HF between the statin-exposed and unexposed trastuzumab cohorts was not statistically significant (2.7%; 95% CI, 1.2%–5.2% vs. 3.7%; 95% CI, 2.0%–6.2%), with a hazard ratio of 0.46 (95% CI, 0.20–1.07). The association in the trastuzumab group did not differ according to prior anthracycline use, low-density lipoprotein levels, or when censoring women with a hospitalization for acute myocardial infarction.
Conclusions:
Statin-exposed women with early breast cancer had a lower risk of HF hospital presentations after early breast cancer chemotherapy involving anthracyclines.
Perspective:
Interest in therapies to prevent cardiotoxicity attributed to cancer treatment has grown in an era in which an increasingly older population with comorbid cardiovascular disease or risk factors is receiving treatment. Studies investigating various preventive therapies—notably statins—were so far heavily limited by their small sample sizes, low event rate, and high risk of selection bias. This relatively large study provides supportive evidence for a potential benefit in statins as a therapy to reduce the risk of cardiotoxicity, which is in line with prior findings. It remains limited due to its observational nature and reliance on administrative data. To definitely conclude beneficial effects of statins in this patient population warrants a clinical trial. Whether such a trial will happen is unclear given the costs involved. Nevertheless, statin therapy should not be shied away from in this patient population given its potential benefit and overall low risk.
Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure
Keywords: Anthracyclines, Breast Neoplasms, Cardiotoxicity, Emergency Service, Hospital, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, LDL, Myocardial Infarction, Pharmaceutical Preparations, Primary Prevention, Risk Factors
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