Role of Statin Therapy in Prevention of Anthracycline-Induced Cardiotoxicity

Abstract Background Recent advances in the treatment of breast cancer have resulted in improved overall cancer survival; however, cancer therapy-related cardiac dysfunction is considered a major adverse effect of several chemotherapeutic agents, particularly anthracyclines. Hence, there is a need to develop proper cardioprotective strategies to limit myocardial injury following chemotherapy. Objective To evaluate the effect of statin therapy on the prevention of anthracycline-induced cardiotoxicity in female patients with breast cancer. Patients and Methods The current study is a prospective, randomized, single-blind, placebo- controlled trial that included a total of 100 female patients with newly diagnosed breast cancer who received anthracycline-based chemotherapy. Patients were randomly assigned in a 1:1 ratio into two groups, the study group in which patients received 40 mg of oral atorvastatin and the control group in which patients received a placebo. A comprehensive echocardiographic examination was performed to all patients before receiving the chemotherapy and at 6 months after, assessment of LV ejection fraction was done by 3D-echocardiography. Results The mean age of patients assigned to the control group was 49.8±10.51 years, while patients assigned to the intervention group had a mean age of 47.84± 9.16 years, both the control group and the intervention group were similar in demographic data and baseline clinical characteristics. There was a highly significant difference between the two groups regarding both the absolute LVEF assessed by 3D-echocardiography at 6 months and the percentage of change compared to baseline values, patients assigned to the control group had mean LVEF of 52.92% at 6 months with a percentage of change reaching -7.06%, while those assigned to the intervention group had mean LVEF reaching 56.22% at 6 months with a percentage of change reaching -3.64% (P-value: 0.008 and 0.004 for the absolute value and percentage of change respectively). There was a significant difference between the two groups regarding the incidence of development of cancer therapy-related cardiac dysfunction (defined as a drop in LVEF of more than 10% and to a value below 53% assessed by 3D echocardiography), among the control group 15 patients (30%) developed CTRCD after 6 months from starting Anthracyclines based chemotherapy, while, among the intervention group only 6 patients (12%) developed CTRCD. (P-value= 0.027) Conclusion Prophylactic use of atorvastatin may prevent the development of cancer therapy- related cardiac dysfunction in breast cancer patients receiving anthracycline- based chemotherapy.