Lower Heart Failure Risk From Statin Use Seen in Women With Breast Cancer

Women receiving treatment for early-stage breast cancer with anthracycline- or trastuzumab-based chemotherapy may have a lower risk of developing heart failure if their therapy includes statins, reports a study published in the Journal of the American Heart Association, with the risk being significantly lower among those receiving anthracyclines.

Both treatment types are associated with cardiotoxicity, and statins are thought to reduce the adverse effects of the oxidative stress from cancer treatments.

The authors conducted their retrospective cohort investigation to see if there were any relationships between statin use and hospitalization or emergency department (ED) use for heart failure if women had received anthracyclines or trastuzumab for breast cancer. All of the women were 66 years or older; were from Ontario, Canada; had their disease diagnosed between January 1, 2007, and December 31, 2017; and received anthracycline- or trastuzumab-based treatment in the first year following their diagnosis.

With a primary outcome of 5-year risk of heart failure, they based their analysis on data from the Canadian Institute of Health Information's Discharge Abstract Database (hospitalization), the National Ambulatory Care Reporting System (ED visits), the Ontario Health Insurance Plan database (claims), the Registered Persons Database (vital statistics), and the Ontario Laboratory Information System (lab test results).

Analyses revealed the following:

• Women in both matched groups were less likely to need heart failure treatment, with those in the anthracycline group being 55% less likely (HR, 0.45; 95% CI, 0.24-0.85; P = .01) and those in the trastuzumab group being 54% less likely (HR, 0.46; 95% CI, 0.20-1.07; P = .07).
• In the anthracycline group, 1.2% (95% CI, 0.5%-2.6%) of the statin-exposed women presented to the hospital with heart failure vs 2.9% (95% CI, 1.7%-4.6%; P = .01) of those unexposed.
• In the trastuzumab group, 2.7% (1.2%-5.2%) and 3.7% (95% CI, 2.0%-6.2%), respectively, developed heart failure.
• Hospitalizations totaled 43 in the anthracycline group after a mean (SD) follow-up of 5.1 (3.1) years.
• Hospitalizations totaled 27 in the trastuzumab group after a mean (SD) follow-up of 4.4 (2.8) years.

Outcomes were investigated among the women who were matched 1:1 for statin exposure or no exposure, with 666 pairs in the anthracycline group and 390 pairs in the trastuzumab group. A majority of both groups presented with stage 2 disease, and the most common comorbidities were diabetes and hypertension.

A subanalysis was also performed on anthracycline exposure among the women in the trastuzumab group (n = 166), and this found a 61% (HR, 0.39; 95% CI, 0.10-1.58; P = .19) lower risk of incident heart failure in the anthracycline‐exposed group compared with 49% (HR, 0.51; (95% CI, 0.19-1.41; P = .19) seen among the unexposed group. Hospitalizations for heart failure equaled 17 and 10, respectively.

“Statin‐exposed women had a lower risk of [heart failure] hospital presentations after early breast cancer chemotherapy involving anthracyclines, with non‐significant trends towards lower risk following trastuzumab,” the authors concluded. “These findings support the development of randomized controlled trials of statins for prevention of cardiotoxicity.”

The authors note how their findings emulate prior studies that linked lower cardiotoxicity risk and statin use, but caution that there are fewer data on the link between statin benefit and trastuzumab exposure. And they note generalization is limited by lack of left ventricular ejection fraction, diastolic function, cardiac biomarker, and biohumoral (bodily fluid) statistics.

Reference

Abdel-Qadir H, Bobrowski D, Zhou L, et al. Statin exposure and risk of heart failure after anthracycline‐ or trastuzumab‐based chemotherapy for early breast cancer: a propensity score‒matched cohort study. J Am Heart Assoc. Published online January 6, 2021. doi:10.1161/JAHA.119.018393