Statins May Help Lessen Effects of Cardiac Damage from Anthracyclines

Marielle Scherrer-Crosbie, MD

Credit: ACC

Among patients with lymphoma receiving chemotherapy regimens containing anthracyclines, those who took atorvastatin for one year were significantly less likely to show evidence of heart dysfunction compared with those who took a placebo, according to new findings.¹

Trial results from the STOP-CA trial suggested statins may help lessen the effects of cardiac damage resulting from anthracycline treatment, particularly in those at elevated risk of heart problems due to older age, higher body mass index, or taking higher doses of anthracyclines.

The late-breaking findings were presented in a session at the American College of Cardiology (ACC) 2023 Annual Scientific Sessions in New Orleans, Louisiana.

“We believe that patients with lymphoma who are treated with anthracyclines and are at a high risk of cardiac dysfunction and heart failure would benefit from statin therapy,” said Marielle Scherrer-Crosbie, MD, professor of medicine, Hospital of the University of Pennsylvania, and the co-lead author of the study. “I think it’s an impactful study that will lead to more prescription of statins in patients.”

As a relatively common side effect of anthracycline treatment, damage to the heart can lead to heart dysfunction and then heart failure. Anthracyclines are the most common chemotherapy used to treat lymphoma and are used for several cancer types. As a result, investigators have sought interventions to reduce the risk of cardiac toxicity associated with the drug class, but success has been limited.

A recent study with a different endpoint focused on patients treated for breast cancer observed that statins did not reduce cardiotoxicity, according to the team. In comparison to breast cancer, treatment regimens for lymphoma often include high doses of anthracyclines.

The STOP-CA trial enrolled 300 patients with lymphoma undergoing treatment with anthracyclines at a median dose of 300 mg/m². Of that population, half were assigned to take 40 mg of atorvastatin and half took a placebo daily, starting before their first dose of anthracyclines and continuing for one year.

Investigators assessed the patients’ left ventricle ejection fraction (LVEF) at baseline and one year. The trial’s primary endpoint was the proportion of patients who experienced a decline in LVEF of 10% or more (to less than 55%, near the lower limit of normal LVEF) from baseline to one year. Secondary endpoints consisted of the reduction in LVEF of 5% or more to less than 55% from baseline to one year.

A total of 286 patients completed the study. Upon analysis, the data suggest the primary endpoint occurred in only 9% of those taking atorvastatin, whereas patients taking a placebo were approximately three times as likely (22%) to see this level of LVEF decline. The secondary endpoint results were additionally significant in favor of atorvastatin.

Moreover, the results indicated no significant differences in the rates of adverse events, including muscle pain or renal failure. At one year, data showed those who took statins had an average ejection fraction that was 1.3% higher than patients who took a placebo.

Investigators indicated that although the absolute difference between the two groups was statistically significant, it was not a large enough magnitude to be clinically relevant when viewed across the entire patient population.

As the current study excluded participants with below-normal LVEF at baseline as well as those with an indication for statins, the population of patients included may have had better overall heart health compared with the general population of people with lymphoma. They noted further studies are required to determine which subgroups of patients may benefit the most from statin use and examine whether statin therapy prevents symptomatic heart failure.

“This effect will also need to be confirmed in terms of symptomatic heart failure, but the endpoint we chose in clinically relevant because those rates of decline in LVEF are associated with later symptomatic heart failure,” Scherrer-Crosbie said. “There is a clear protective effect of atorvastatin in terms of cardiac dysfunction in patients with lymphoma treated with anthracyclines.”

References

1. Scherrer-Crosbie M. Statins To Prevent The Cardiotoxicity From Anthracyclines: The STOP-CA Trial. American College of Cardiology (ACC) 2023 Annual Scientific Sessions. In: New Orleans, Louisiana.