INTRODUCTION:

Cancer therapy-induced cardiac dysfunction is a significant adverse effect of chemotherapeutic agents, particularly anthracyclines (ANT). High-potency statin therapy, such as atorvastatin, appears to exert a protective effect against this condition.

OBJECTIVE:

We aimed to perform a meta-analysis to evaluate the effect of atorvastatin therapy in preventing anthracycline-induced cardiotoxicity in cancer patients.

METHODS:

We searched PubMed and Web of Science for randomized controlled trial (RCT) studies comparing atorvastatin prophylactic use to placebo in patients with cancer undergoing anthracycline-based chemotherapy.

Outcomes were:

mean change in left ventricular ejection fraction (LVEF), LVEF final, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), LDL-c, cancer treatment related cardiac disease (CTRCD) and heart failure symptoms. A random effects model was used to calculate the risk ratios (RRs) and mean difference (MDs) with 95% confidence intervals. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics.

RESULTS:

Five RCTs with 831 participants were included. The median follow-up ranged from 1 to 24 months. The dose used in all studies was 40 mg. Breast cancer was present in 77% of the patients. In our analysis, atorvastatin prophylactic use was associated with a statistically significant lower LVEF final (MD 2.31 %; 95% IC [0,78; 3,84]; p<0.01; I2 =65%), LVESV (MD -4.50 mL; 95% IC [-7,57; -1,44]; p<0.01; I2 =0%), LVEDV (MD -6.08 mL; 95% IC [-11,27; -0,90]; p=0.02; I2 =0%), LDL-c (MD -38.11 mg/dL; 95% IC [-55,01; -21,20]; p<0.01; I2 =89%) and CTRCD (RR 0.42; 95% CI 0.28 - 0.65; p<0.001; I2 =0%). In addition, atorvastatin prophylactic use was associated with a statistically significant increased LVEF final (MD 2.31 %; 95% IC [0,78; 3,84]; p<0.01; I2 = 65%). There was no significant difference between groups in terms of mean change LVEF (MD 2.56 %; 95% IC [-0,20; 5,32]; p=0.07; I2 =89%) and heart failure symptoms (RR 0.40; 95% CI 0.14 - 1.18; p=0.097; I2 =0%).

CONCLUSION:

In conclusion, atorvastatin prophylactic use to placebo in patients with cancer undergoing anthracycline-based chemotherapy was associated with a reduction in LVESV, LVEDV, CTRCD and an increase in LVEF final. There was no difference between groups regarding mean change LVEF and heart failure symptoms.