Statin Use Could Reduce Risk of Cardiotoxicity from Anthracyclines and Trastuzumab

Husam Abdel-Qadir, MD, PhD

An analysis of women undergoing breast cancer treatment suggests use of statins could reduce the cardiotoxicity of cancer treatment with trastuzumab or anthracyclines in patients with heart failure.

Results of the study, which included more than 1000 pairs of women treated with either anthracyclines or trastuzumab, indicate women also taking statins were half as likely to be hospitalized or visit an emergency department for heart failure within 5 years after chemotherapy.

"Two types of cancer medications, anthracyclines and trastuzumab, are effective treatments for many women with breast cancer, however, the risk of heart muscle damage has limited their use, particularly in women who are at higher risk for heart problems because of their age or other medical issues," said lead author Husam Abdel-Qadir, MD, PhD, a cardiologist at Women's College Hospital and the Peter Munk Cardiac Centre, part of the University Health Network in Toronto, in a statement from the American Heart Association. "The mechanisms for these medications are essential to kill breast cancer cells, however, these processes can also damage the cells of the heart muscle, leading to weakening of the heart.”

Building on previous research, Abdel-Qadir and colleagues designed their study as analysis of data from multiple administrative databases in Canada. Using a period lasting from 2007-2017, investigators sought to assess the occurrence of heart failure in women aged 66 or older receiving either of the aforementioned cancer therapies for newly diagnosed breast cancer.

After propensity matching statin-exposed in unexposed women, investigators identified 666 pairs of anthracycline-treated women and 390 pairs of trastuzumab for inclusion in their analysis. Among statin-exposed women in the anthracycline cohort, 309 used rosuvastatin, 272 used atorvastatin, 51 used simvastatin, and 27 used pravastatin. Among statin-exposed women in the trastuzumab cohort, 182 used rosuvastatin, 161 used atorvastatin, and 31 used simvastatin.

Results indicated the 5-year cumulative incidence of heart failure hospital presentations after anthracycline treatment was 1.2% (95% CI, 0.5-2.6) in statin-exposed women and 2.9% (95% CI, 1.7-4.6). Further analysis indicated the cause-specific hazard ratio associated with statin use in women treated with anthracycline was 0.45 (95% CI, 0.24-0.85; P=.01).

Among those treated with trastuzumab, the 5-year cumulative incidence of heart failure hospital presentations was 2.7% (95% CI, 1.2-5.2) in statin-exposed women and 3.7% (95% CI, 2.0-6.2) in unexposed women (P=.09). Further analysis indicated the cause-specific hazard ratio associated with statin use in women treated with trastuzumab was 0.46 (95% CI,0.20-1.07; P=.07).

In a statement from the University Health Network, Abdel-Qadir cautioned against overinterpretation of study results but also noted clinicians should be aware of potential cardiotoxicity from use of these treatments.

"In order to know whether it's a true cause and effect relationship, we need to do a proper randomized control trial," added Abdel-Qadir, who is also part of the Ted Rogers Centre for Heart Research (TRCHR) Cardiotoxicity Prevention Program. "For the time being, if a woman is supposed to be starting treatment for breast cancer and already has an established indication to be on a statin, there's now additional motivation to start it or stay on it."

This study, “Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study,” was published in the Journal of the American Heart Association.