Statins May Protect Heart From Breast Cancer Therapy Damage

Giving statins to women before they undergo treatment for breast cancer may help prevent the heart damage caused by some well-known therapies, including trastuzumab, according to results to be released as part of the American College of Cardiology Scientific Session, with the World Congress of Cardiology (ACC.20/WCC).

The results, released ahead of the first-ever virtual meeting as part of ACC’s annual consumer briefing, found that women who were on a statin prior to being treated with anthracyclines or trastuzumab had a much lower risk of developing heart failure over the next 5 years, compared with those who were not on a statin.

Lead investigator David Bobrowski, a third-year medical student at the University of Toronto, said during the briefing that the cardiotoxicity and heart failure risk of anthracyclines and trastuzumab are well-established, “but because of their effectiveness in breast cancer, we cannot forego their use.”

Smaller studies have suggested statins might offer a protective effect against heart failure, and the University of Toronto project examined a larger group and took a different approach to defining heart failure—one more useful to patients and health systems.

Overall heart failure risk was 58% lower for those treated with anthracyclines and 66% for those on trastuzumab, based on a population health study of electronic health records (EHRs) for 2545 women treated with anthracyclines and 1345 treated with trastuzumab in Ontario, Canada.

“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 in a statement.

Details of the study were:

• Women included in the study were aged 66 years or older without a history of heart failure when diagnosed with early stage breast cancer between 2007 and 2017.
• Of this group, 953 women treated with anthracycline and 568 given trastuzumab were found to have been prescribed a statin. Researchers acknowledged they could not confirm that the women took the statins.
• Researchers created 723 matched pairs of anthracycline-treated women (average age 69 years) and 399 matched pairs of trastuzumab-treated women (average age 71 years) with similar women who not been taking statins.

This study examined whether women appeared at the emergency department with “clinically overt heart failure,” instead of limiting the definition to left ventricle function. Bobrowski explained that these results are very important to health systems, because this is a more “clear-cut outcome that carries more relevance to cancer patients and their physicians.”

The mechanism behind statins’ potential cardioprotective effect for patients receiving anthracycline was explained in a 2017 article in Cell Death and Disease. The authors wrote that statins have anti-inflammatory and anti-fibrotic properties and interrupt the generation of ROS and topoisomerase II inhibition; also, statins may make the tumor more sensitive to chemotherapy while protecting normal tissue, “thus widening the therapeutic window.”

As more patients survive cancer, it is more likely that that women will develop heart disease, Bobrowski explained. More women may be treated with trastuzumab as biosimilar options reach the market.

“The findings provide impetus for future prospective trials to determine whether initiating a statin before receiving anthracycline-based chemotherapy or trastuzumab can effectively prevent cardiotoxic events,” he said.

ACC.20/WCC will take place March 28-30, 2020, as a virtual meeting due to COVID-19, which forced the cancellation of the in-person Chciago, Illinois meeting. Visit here for full coverage.

Reference

Bobrowski D, Zhou L, Austin P, et al. Statins are associated with lower risk of heart failure after anthracycline and trastuzumab chemotherapy for early stage breast cancer. To be presented at ACC.20/WCC, March 28-30, 2020; Abstract 20-A-12918.