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Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials
Cardiotoxicity occurs in 5–20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines. PubMed and Scopus electronic databases were scanned...
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| Published in: | International journal of cardiology 2023-11, Vol.391, p.131219-131219, Article 131219 |
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| container_end_page | 131219 |
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| container_title | International journal of cardiology |
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| creator | D'Amario, Domenico Laborante, Renzo Bianchini, Emiliano Galli, Mattia Ciliberti, Giuseppe Mennuni, Marco Patti, Giuseppe |
| description | Cardiotoxicity occurs in 5–20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines.
PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed.
On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33–0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66–3.1, P |
| doi_str_mv | 10.1016/j.ijcard.2023.131219 |
| format | article |
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PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed.
On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33–0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66–3.1, P < 0.01; I2 = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 – +4.79, P = 0.05; I2 = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF.
The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
The statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group, as well as higher mean LVEF and a more favorable ∆LVEF during follow-up, despite no significant difference in terms of hospitalization for HF during the available follow-up Abbreviations: CMR, cardiac magnetic resonance; HF, Heart Failure; LVEF, left ventricular ejection fraction; MD, median difference; RCTs: Randomized controlled trials, RR, risk ratio. [Display omitted]
•Statins may represent a promise in mitigating cardiotoxicity mediated by anthracyclines.•The current meta-analysis, encompassing 808 cancer patients from 5 RCTs, shows a beneficial effect of statins in preventing left ventricular dysfunction after anthracyclines treatment, evidenced by both lower incidence of cardiotoxicity and smaller mean change in LVEF in statin-treated patients compared to placebo.•No difference in the occurrence of heart failure hospitalization was found.•Larger randomized controlled trials are required to confirm these results and further investigate statin impact on prognosis.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2023.131219</identifier><identifier>PMID: 37527752</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Anthracyclines ; Cardio-oncology ; Cardiotoxicity ; Statin</subject><ispartof>International journal of cardiology, 2023-11, Vol.391, p.131219-131219, Article 131219</ispartof><rights>2023</rights><rights>Copyright © 2023. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-2198e161989936d2e109e7c4e9bb8eabf5c2cf101dcc268c006b1b56dfc5477f3</citedby><cites>FETCH-LOGICAL-c362t-2198e161989936d2e109e7c4e9bb8eabf5c2cf101dcc268c006b1b56dfc5477f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37527752$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D'Amario, Domenico</creatorcontrib><creatorcontrib>Laborante, Renzo</creatorcontrib><creatorcontrib>Bianchini, Emiliano</creatorcontrib><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Ciliberti, Giuseppe</creatorcontrib><creatorcontrib>Mennuni, Marco</creatorcontrib><creatorcontrib>Patti, Giuseppe</creatorcontrib><title>Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Cardiotoxicity occurs in 5–20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines.
PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed.
On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33–0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66–3.1, P < 0.01; I2 = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 – +4.79, P = 0.05; I2 = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF.
The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
The statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group, as well as higher mean LVEF and a more favorable ∆LVEF during follow-up, despite no significant difference in terms of hospitalization for HF during the available follow-up Abbreviations: CMR, cardiac magnetic resonance; HF, Heart Failure; LVEF, left ventricular ejection fraction; MD, median difference; RCTs: Randomized controlled trials, RR, risk ratio. [Display omitted]
•Statins may represent a promise in mitigating cardiotoxicity mediated by anthracyclines.•The current meta-analysis, encompassing 808 cancer patients from 5 RCTs, shows a beneficial effect of statins in preventing left ventricular dysfunction after anthracyclines treatment, evidenced by both lower incidence of cardiotoxicity and smaller mean change in LVEF in statin-treated patients compared to placebo.•No difference in the occurrence of heart failure hospitalization was found.•Larger randomized controlled trials are required to confirm these results and further investigate statin impact on prognosis.</description><subject>Anthracyclines</subject><subject>Cardio-oncology</subject><subject>Cardiotoxicity</subject><subject>Statin</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLLDEQRoMoOj7-gUiWd9Njkn67EER8geBCXYd0pRozdCdjkhlu--tvhta7dJFUCKfqow4h55wtOePV5WppVqC8Xgom8iXPueDtHlnwpi4yXpfFPlkkrM5KUedH5DiEFWOsaNvmkBzldfpNZ0Hca1TR2EBVoGuPW7TRbJHGD_RqPdHeeaps_PAKJhiMRbqLNC66vwZMnK6ooiNGlSmrhimYQF1PvbLajeYLNQVno3fDkJ7RGzWEU3LQp4Jn3_WEvN_fvd0-Zs8vD0-3N88Z5JWIWdqlQV6lu23zSgvkrMUaCmy7rkHV9SUI6JMHDSCqBhirOt6Vle6hLOq6z0_In3nu2rvPDYYoRxMAh0FZdJsgRVOUnJVpekKLGQXvQvDYy7U3o_KT5EzuVMuVnFXLnWo5q05tF98Jm25E_b_px20CrmcA055bg14GMGgBtfEIUWpnfk_4B-P5k9w</recordid><startdate>20231115</startdate><enddate>20231115</enddate><creator>D'Amario, Domenico</creator><creator>Laborante, Renzo</creator><creator>Bianchini, Emiliano</creator><creator>Galli, Mattia</creator><creator>Ciliberti, Giuseppe</creator><creator>Mennuni, Marco</creator><creator>Patti, Giuseppe</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20231115</creationdate><title>Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials</title><author>D'Amario, Domenico ; Laborante, Renzo ; Bianchini, Emiliano ; Galli, Mattia ; Ciliberti, Giuseppe ; Mennuni, Marco ; Patti, Giuseppe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-2198e161989936d2e109e7c4e9bb8eabf5c2cf101dcc268c006b1b56dfc5477f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anthracyclines</topic><topic>Cardio-oncology</topic><topic>Cardiotoxicity</topic><topic>Statin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D'Amario, Domenico</creatorcontrib><creatorcontrib>Laborante, Renzo</creatorcontrib><creatorcontrib>Bianchini, Emiliano</creatorcontrib><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Ciliberti, Giuseppe</creatorcontrib><creatorcontrib>Mennuni, Marco</creatorcontrib><creatorcontrib>Patti, Giuseppe</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D'Amario, Domenico</au><au>Laborante, Renzo</au><au>Bianchini, Emiliano</au><au>Galli, Mattia</au><au>Ciliberti, Giuseppe</au><au>Mennuni, Marco</au><au>Patti, Giuseppe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2023-11-15</date><risdate>2023</risdate><volume>391</volume><spage>131219</spage><epage>131219</epage><pages>131219-131219</pages><artnum>131219</artnum><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>Cardiotoxicity occurs in 5–20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines.
PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed.
On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33–0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66–3.1, P < 0.01; I2 = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 – +4.79, P = 0.05; I2 = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF.
The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
The statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group, as well as higher mean LVEF and a more favorable ∆LVEF during follow-up, despite no significant difference in terms of hospitalization for HF during the available follow-up Abbreviations: CMR, cardiac magnetic resonance; HF, Heart Failure; LVEF, left ventricular ejection fraction; MD, median difference; RCTs: Randomized controlled trials, RR, risk ratio. [Display omitted]
•Statins may represent a promise in mitigating cardiotoxicity mediated by anthracyclines.•The current meta-analysis, encompassing 808 cancer patients from 5 RCTs, shows a beneficial effect of statins in preventing left ventricular dysfunction after anthracyclines treatment, evidenced by both lower incidence of cardiotoxicity and smaller mean change in LVEF in statin-treated patients compared to placebo.•No difference in the occurrence of heart failure hospitalization was found.•Larger randomized controlled trials are required to confirm these results and further investigate statin impact on prognosis.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37527752</pmid><doi>10.1016/j.ijcard.2023.131219</doi><tpages>1</tpages></addata></record> |
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| subjects | Anthracyclines Cardio-oncology Cardiotoxicity Statin |
| title | Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials |
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