Toronto—Chemotherapy, including anthracycline and the targeted cancer medication trastuzumab, is commonly used to treat breast cancer. While lifesaving, these drugs also can trigger heart failure (HF) in some patients. 

A presentation at the recent American College of Cardiology’s Annual Scientific Session/World Congress of Cardiology (ACC.20/WCC) meeting suggests one of the most widely prescribed medications in the world could be protective. 

University of Toronto–led researchers looked at whether statins could help reduce heart damage from those breast cancer therapies, which are estimated to be used in nearly a fourth of women in early stage breast cancer.

“To date, there has been limited evidence supporting the safety and effectiveness of large-scale use of cardioprotective medications for patients with early stage breast cancer. Angiotensin antagonists and beta blockers have shown only modest cardioprotective effects in clinical trials, and these medicines are sometimes poorly tolerated in this population, given their side effects of fatigue and dizziness, which many patients already have from their cancer therapies or the cancer itself,” explained lead author David Bobrowski, medical student at the University of Toronto. “Our results suggest that taking statins is associated with a significantly lower risk of developing heart failure requiring hospital-based care among women with early stage breast cancer who received one of these cancer therapies.”

Over the median 5-year follow-up, researchers determined that, compared with women who were not on a statin before undergoing cancer treatment, women who were taking statins while receiving anthracyclines or trastuzumab had significantly lower risk of developing heart failure—58% and 66% respectively.

The study team conducted a population-based retrospective cohort study of women aged 66 years and older diagnosed with early stage breast cancer in Ontario from 2007to 2017. The focus in the linked-database study was on women who received anthracyclines or trastuzumab in the year after diagnosis as separate cohorts. 

Propensity scores (PS) were used to match statin-treated with unexposed women (1:1) in each cohort; trastuzumab-treated women were also matched on prior anthracycline use.

From 2,545 anthracycline-treated women and 1,345 trastuzumab-treated women, researchers matched 723 statin-discordant pairs of anthracycline-treated women (median age 69 years) and 399 pairs of trastuzumab-treated patients (median age 71 years). 

Results indicate that the risk of HF hospital visits in both cohorts was significantly lower with statin exposure, with the cause-specific hazard ratio being 0.42 (95% CI, 0.22-0.82) in the anthracycline cohort and 0.34 (95% CI, 0.14-0.82) in the trastuzumab cohort.

“Our research expands on earlier, smaller studies. If these associations are confirmed in a prospective trial, this will represent an important step forward to optimize cancer outcomes by decreasing the trade-off of long-term cardiac disease or related deaths,” Bobrowski said.

The study was touted as the largest to examine the how statins might protect against treatment-related heart failure.  

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