Statin Use Can Attenuate the Decline in Left Ventricular Ejection Fraction and the Incidence of Cardiomyopathy in Cardiotoxic Chemotherapy Recipients: A Systematic Review and Meta-Analysis.

Jean Kim,Yoshito Nishimura,James Yess,Jakrin Kewcharoen

doi:10.3390/jcm10163731

Abstract

There is insufficient evidence about the cardioprotective effects of statins against chemotherapy-induced cardiomyopathy. The MEDLINE and EMBASE databases were searched from inception to March 2021 for studies that reported the mean left ventricular ejection fraction (LVEF) before and after chemotherapy and the incidence of chemotherapy-induced cardiotoxicity in patients who received concurrent statin therapy and those who received chemotherapy alone. A random effects meta-analysis was performed to obtain the pooled weighted mean difference (WMD) and the 95% confidence interval (CI) for the mean final LVEF and the mean LVEF change, and the pooled odds ratio (OR) and the 95% CI of the incidence of chemotherapy-induced cardiomyopathy. Seven studies with 3042 patients were included in this meta-analysis (statin group: 1382 patients received concurrent statin with chemotherapy; control group: 1660 patients received chemotherapy alone). Patients in the control group had a more significant decline in LVEF (WMD = −6.08%, 95% CI: −8.55 to −3.61, p < 0.001) compared to those in the statin group. Additionally, the statin group had a significantly lower incidence of chemotherapy-induced cardiomyopathy compared to the control group (OR = 0.41, 95% CI = 0.28–0.60, p < 0.001). Consequently, our study showed a significant reduction in the incidence of chemotherapy-induced cardiomyopathy and the degree of LVEF decline in patients in the statin group compared to those in the control group.

Highlights

Cancer is one of the leading causes of mortality worldwide, with 9.9 million cancerrelated deaths reported in 2020 [1,2,3,4]
The MEDLINE and EMBASE databases were searched from inception to March 2021 for studies that reported the mean left ventricular ejection fraction (LVEF) before and after chemotherapy and the incidence of chemotherapy-induced cardiotoxicity in patients who received concurrent statin therapy and those who received chemotherapy alone
Patients in the control group had a more significant decline in LVEF (WMD = −6.08%, 95% confidence interval (CI): −8.55 to −3.61, p < 0.001) compared to those in the statin group

Summary

Introduction

Cancer is one of the leading causes of mortality worldwide, with 9.9 million cancerrelated deaths reported in 2020 [1,2,3,4]. Patients receiving anthracyclines such as doxorubicin and HER2/neu receptor monoclonal antibodies including trastuzumab are more at risk of developing CIC [14]. Patients who develop CIC have been shown to have up to 3.5 times higher risk of mortality than those with cardiomyopathy from other causes. It may be because those with CIC often have sub-clinical disease progression in the early stages, with overt changes in symptoms only after they have sustained a significant level of cardiac damage [13], and limited preventive and treatment options are available, such as beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) [15,16]

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Results

Conclusion