Abstract 14081: Statin Therapy Concomitant with Anthracycline Chemotherapy for Breast Cancer is Associated with Reduced Risk of Heart Failure and Cardiac Related Mortality
Background Recent animal model and in vitro experimental studies have reported statins to prevent doxorubicin-related cardiotoxicity. The current study evaluates the cardioprotective effect of statins during chemotherapy in a routine clinical setting.
Methods Clinical findings were entered prospectively in electronic medical records for 628 consecutive newly diagnosed women with breast cancer that were treated with anthracyclines between 2005 and 2010. To reduce selection bias due to different characteristics of the statin-treated group (n = 67), a propensity score predicting the probability of receiving statins was first computed by using multiple logistic regression. A matched case-cohort (1:2) subset of 201 pts (67:134) was assembled using the propensity score, with additional matching by follow-up time. The primary outcome was incident heart failure (HF), with a composite outcome of HF cases and cardiac death (HFD).
Results Of 201 pts followed for 1.8 (0.8-3.7) years, 19 developed new HF; there were 2 cardiac deaths. The propensity score allowed matching for age >55y, hypertension, diabetes, atherosclerotic vascular disease, and ACE inhibition (associated with statin use). HF was associated with age <55y, trastuzumab, and African-American race (Figure). Statins at the time of chemotherapy reduced the risk of HF and HFD by 6-fold. Cardioprotection was associated with statins after age adjustment (OR=0.2, 95% C.I. 0.04-0.9, p=0.03), and full adjustment for age, race, neighbourhood income, Charlson score, BMI, smoking, radiotherapy, trastuzumab, therapy with ACE-inhibitors and beta-blockers, LDL, and follow-up time (OR=0.13, 95% C.I. 0.02-0.83, p=0.03).
Conclusion Statins showed cardioprotective effects in breast cancer patients receiving anthracyclines. Further studies should determine if pre-treatment with statins may attenuate cardiotoxicity related to chemotherapy, via antioxidative and anti-inflammatory effects.
- © 2011 by American Heart Association, Inc.