Key result
Atorvastatin cuts the odds of a ≥3% myocardial ECV increase by ~80% versus placebo.
Why the study?
Atorvastatin preserved left ventricular ejection fraction in patients with lymphoma treated with anthracyclines, but the protective mechanisms remained unclear.
Does atorvastatin prevent anthracycline-associated increase in myocardial extracellular volume in patients with lymphoma?
RCT (n=171)
Does atorvastatin prevent anthracycline-associated increase in myocardial extracellular volume in patients with lymphoma?
Atorvastatin significantly reduces myocardial extracellular volume expansion in patients receiving anthracycline chemotherapy, offering a mechanistic explanation for its cardioprotective benefits.
Answers are grounded in this paper and cite their sources.
Atorvastatin attenuates anthracycline-related ECV expansion in lymphoma; extends low-certainty observational data with RCT evidence.
BACKGROUND: In the STOP-CA (Statins to Prevent the Cardiotoxicity From Anthracyclines) trial, atorvastatin preserved the left ventricular ejection fraction among patients with lymphoma treated with anthracyclines. The protective mechanisms are currently unclear. OBJECTIVES: The aim of this study was to test the effect of atorvastatin on the anthracycline-associated increase in myocardial extracellular volume (ECV) using cardiac magnetic resonance imaging (MRI). METHODS: Cardiac MRI with mapping was performed at baseline and at 12-month follow-up. ECV was calculated, and the primary endpoint was a ≥3% increase. Increases of ≥1 SD in native T1 and T2 times and ECV were secondary endpoints. RESULTS: The subgroup included 171 participants with paired cardiac MRI scans, and 127 had contrast scans of appropriate quality (median age 52 years, 47% women). The proportion of participants with ≥3% increases in ECV was lower in the atorvastatin compared with the placebo group (8% vs 29%; P = 0.002; OR: 0.20; 95% CI: 0.06 to 0.59). A ≥3% increase in ECV was associated with an 8.4% decrease in left ventricular ejection fraction at follow-up (95% CI: -6.31 to -10.38; P < 0.001). The proportion of participants with ≥1-SD increases in T1 and T2 times was statistically similar between groups at 12 months. At 24 months, there were fewer heart failure events among those without ≥3% increases in ECV (8% vs 24%; P = 0.054), though not statistically significantly. CONCLUSIONS: Compared with placebo, atorvastatin limited ECV expansion among participants with lymphoma undergoing anthracycline chemotherapy. This study is the first to provide mechanistic insight into statins' cardioprotective effects with anthracyclines. (Statins to Prevent the Cardiotoxicity From Anthracyclines [STOP-CA]; NCT02943590).
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Juhász et al. (2025) conducted an RCT in Lymphoma treated with anthracyclines (n=171). Atorvastatin vs. Placebo was evaluated on ≥3% increase in myocardial extracellular volume (ECV) (OR 0.20, 95% CI 0.06 to 0.59, p=0.002). Atorvastatin significantly reduced the proportion of patients with a ≥3% increase in myocardial extracellular volume compared with placebo (8% vs 29%; OR 0.20; 95% CI 0.06-0.59; P=0.002).
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