Blood rich in oxygen is pumped from the left ventricle (bottom right) to the aorta (top right), where it is reintroduced into the bloodstream. Anthracyclines have the potential to harm the heart, impairing the left ventricle’s ability to pump effectively.
Results from a clinical research reveal that decreasing cholesterol may help lessen the risk of heart failure in patients with cancer receiving chemotherapy medicines called anthracyclines.
Numerous forms of cancer are treated with anthracyclines, including doxorubicin. However, these medications may impair the heart’s capacity to pump blood, which could result in heart failure.
In the experiment, participants receiving anthracycline treatment had a lower risk of certain cardiac alterations associated with heart failure when taking atorvastatin (Lipitor).
The most often given kind of statin, a class of medications that decrease cholesterol and are used to help prevent heart disease, is atorvastatin. Before receiving their first anthracycline infusion, participants were randomly randomised to receive either atorvastatin or a placebo for a duration of one year.
Individuals on atorvastatin had a lower probability of experiencing reductions in left ventricular ejection fraction, a measure of heart health, one year later. The heart’s capacity to pump blood to other bodily parts is gauged by the ejection fraction. Heart failure risk rises as the ejection fraction falls.
The scientists concluded that the data, which were published in JAMA on August 8, may justify the use of atorvastatin in certain lymphoma patients who are at risk of heart issues as a result of receiving anthracycline-based chemotherapy.
Study co-leader Tomas Neilan, M.D., of Massachusetts General Hospital, stated, “We believe that some patients with lymphoma who are being treated with a certain type of cancer drug called anthracyclines may benefit from the statin therapy.”
Additionally, he said that the statin medication was “very safe.” Between the two groups, there were comparable incidences of side effects, such as muscle soreness, which is a typical statin side effect.
The new findings would justify continuing statin use during anthracycline-based chemotherapy for those who are already taking them at the time of their lymphoma diagnosis, according to Dr. Neilan.
But he issued a warning: as no comparable trials have been carried out for patients with other malignancies, the current findings are limited to those who have lymphoma.
The adverse consequences of cancer therapy on the heart
Cancer cells are damaged by anthracyclines, such as daunorubicin, doxorubicin, and epirubicin, which ultimately results in the death of the cells.
“A class of very potent cancer drugs known as anthracyclines has been used since the 1970s,” stated Marielle Scherrer-Crosbie, M.D., Ph.D., co-leader of the study and employee of the Hospital of the University of Pennsylvania in Philadelphia.
These drugs are a common component of chemotherapy regimens that are mostly used to treat lymphomas, sarcomas, leukaemias, and certain types of breast cancer. I added, Dr. Scherrer-Crosbie.
Studies have shown that 20% of individuals with lymphoma experience a reduction in left ventricular ejection fraction of more than 10% within a year of beginning anthracycline therapy. Up to 20% of high-risk people get heart failure within 5 years.
Statins may help shield the heart from the effects of chemotherapy that contains anthracyclines, according to research conducted on cells and animals. Additionally, data from clinical trials suggests that those receiving anthracycline-treated cancer and routinely taking statins for heart disease may be less likely than those not to experience heart failure.
Who ought to take statins?
In a modest trial including patients with a variety of malignancies, atorvastatin had previously demonstrated promise as a heart-protective medication. Dr. Scherrer-Crosbie and her associates chose atorvastatin for the current experiment based on that findings.
Three hundred lymphoma patients participated in the Statins TO Prevent the Cardiotoxicity from Anthracyclines (STOP-CA) trial. The majority of participants were White, the median age was 52, and they had non-Hodgkin lymphoma.
Overall, the left ventricular ejection fraction decreased by more than 10% in 13 of 150 (9%) individuals taking atorvastatin, compared to 33 of 150 (22%) patients receiving a placebo.
The findings show that statins can either prevent or reduce the severity of cardiac side effects brought on by chemotherapy with anthracyclines, according to Patrice Desvigne-Nickens, M.D., a heart failure researcher and medical officer at the National Heart, Lung, and Blood Institute who was not involved in the trial.
“How to use statins in patients receiving anthracycline treatment is still unclear,” she said. “More research is required to identify the patients most likely to benefit from statin treatments, the best dosages, and the best times and durations for using statins.”
Since the results were released, a number of cancer physicians have questioned Dr. Neilan about which patients may benefit from statin therapy. “The response to this inquiry is contingent upon an individual’s anthracycline dosage and heart failure risk,” he stated.
For example, an elderly patient who is overweight and has other cardiac risk factors may benefit from statin therapy, but a young patient with no significant cardiac risk factors is unlikely to develop heart failure and thus would not benefit from the medication, according to Dr. Neilan.
Researching the physiology of cardiac damage
Cardiovascular issues, such as high blood pressure, irregular heart rhythms, and heart failure, can be brought on by chemotherapy or made worse by it. If cardiac adverse effects arise during cancer treatment, physicians may choose to halt or modify the course of treatment. It’s possible for symptoms to appear years after cancer therapy.
The cardiac adverse effects of anthracyclines could be explained by a number of different biological pathways, according to Dr. Scherrer-Crosbie. Research has examined the potential impact of anthracyclines on the generation of reactive oxygen species, which are chemicals that might cause harm to heart muscle cells.
Typically, statin medications are used to reduce cholesterol and avoid heart attacks brought on by coronary artery blockages. However, atorvastatin might help lymphoma patients in a different way, according to the researchers.
“In animal models, we see inflammation in cardiac muscle cells and some of these cells die when we give anthracyclines,” Dr. Neilan stated. “This effect can be lessened with statin therapy.”
He continued, “atorvastatin may help sustain the heart’s pumping function by preventing damage to heart muscle cells.”
According to Dr. Desvigne-Nickens, the new findings ought to stimulate more investigation into ways to safeguard the cardiovascular system while treating cancer. Studies on atorvastatin’s potential to lessen cardiac adverse effects in certain anthracycline-treated breast cancer patients are now underway.
According to Dr. Desvigne-Nickens, “much more needs to be learned about the cardiac side effects of current therapies.” Additionally, we must be mindful of any possible cardiac side effects that can result from combining different medications or novel therapeutic approaches.