Statin use significantly reduced the risk of cardiotoxicity by 54% (RR 0.46) compared to no statin use in cohort studies of cancer patients treated with anthracyclines and/or trastuzumab.
Meta-Analysis (n=930)
Does statin use lower the risk of cardiotoxicity among cancer survivors treated with anthracyclines and/or trastuzumab?
Statin use during anthracycline and/or trastuzumab therapy is associated with a significantly lower risk of cardiotoxicity in observational studies and better preservation of left ventricular ejection fraction across both observational and randomized trials.
Effect estimate: RR 0.46 (95% CI 0.27-0.78)
p-value: p=0.004
Abstract Purpose Cardiotoxicity affects 5–16% of cancer patients who receive anthracyclines and/or trastuzumab. Limited research has examined interventions to mitigate cardiotoxicity. We examined the role of statins in mitigating cardiotoxicity by performing a systematic review and meta-analysis of published studies. Methods A literature search was conducted using PubMed, Embase, Web of Science, ClinicalTrials. gov, and Cochrane Central. A random-effect model was used to assess summary relative risks (RR), weighted mean differences (WMD), and corresponding 95% confidence intervals. Testing for heterogeneity between the studies was performed using Cochran’s Q test and the I 2 test. Results Two randomized controlled trials (RCTs) with a total of 117 patients and four observational cohort studies with a total of 813 patients contributed to the analysis. Pooled results indicate significant mitigation of cardiotoxicity after anthracycline and/or trastuzumab exposure among statin users in cohort studies RR = 0. 46, 95% CI (0. 27–0. 78), p = 0. 004, I^2 I 2 = 0. 0% and a non-significant decrease in cardiotoxicity risk among statin users in RCTs RR = 0. 49, 95% CI (0. 17–1. 45), p = 0. 20, I^2 I 2 = 5. 6%. Those who used statins were also significantly more likely to maintain left ventricular ejection fraction compared to baseline after anthracycline and/or trastuzumab therapy in both cohort studies weighted mean difference (WMD) = 6. 14%, 95% CI (2. 75–9. 52), p I 2 = 74. 7% and RCTs WMD = 6. 25%, 95% CI (0. 82–11. 68, p = 0. 024, I^2 I 2 = 80. 9%. We were unable to explore publication bias due to the small number of studies. Conclusion This meta-analysis suggests that there is an association between statin use and decreased risk of cardiotoxicity after anthracycline and/or trastuzumab exposure. Larger well-conducted RCTs are needed to determine whether statins decrease risk of cardiotoxicity from anthracyclines and/or trastuzumab. Trial Registration Number and Date of Registration PROSPERO: CRD42020140352 on 7/6/2020.
Obasi et al. (Wed,) conducted a meta-analysis in Cancer treated with anthracyclines and/or trastuzumab (n=930). Statins vs. No statin or placebo was evaluated on Incidence of cardiotoxicity (RR 0.46, 95% CI 0.27-0.78, p=0.004). Statin use significantly reduced the risk of cardiotoxicity by 54% (RR 0.46) compared to no statin use in cohort studies of cancer patients treated with anthracyclines and/or trastuzumab.