Statins may protect older women with breast cancer from chemo-induced heart damage

Taking cholesterol-lowering drugs during chemotherapy for early-stage breast cancer may help protect older women from heart damage, new research shows.

The study, published Wednesday in the Journal of the American Heart Association, found women in their late 60s and 70s who took statins while receiving chemotherapy medicines known as anthracyclines were half as likely to require emergency department visits or hospitalization for heart failure in the five years following cancer treatment, compared to those who didn't take statins.

"This study does not conclusively prove statins are protective," the study's lead researcher Dr. Husam Abdel-Qadir said in a news release. He is an assistant professor of medicine at the University of Toronto's Institute of Health Policy, Management and Evaluation. However, it "builds on the body of evidence suggesting that they may have benefits."

Anthracycline chemotherapy is effective for treating breast cancer in its early stages, but also can increase a woman's risk for heart damage. Likewise, trastuzumab, a cancer medication often used during or following anthracycline chemotherapy for HER2-positive breast cancer, has been shown to increase the risk for heart failure.

The new study analyzed data for Canadian women ages 66 and older who had newly diagnosed, early-stage breast cancer and who were treated with anthracycline chemotherapy and/or trastuzumab between 2007 and 2017. None of the women had previously experienced heart failure, but all were at high risk for heart problems because of their age.

Women taking statins prior to and during their cancer treatments were compared with those not taking statins. Researchers then analyzed the data to see how many women needed to visit the hospital or emergency room because of heart failure within five years after their cancer treatments.

Among women who received anthracyclines, those taking statins were 55% less likely to be treated at the hospital for heart failure – 1.2% compared with 2.9%.

The study found women who took statins along with trastuzumab also were less likely to require heart failure treatment compared to those who didn't take statins. However, those findings fell short of statistical significance.

Abdel-Qadir said the cancer medications are effective treatments, but "the risk of heart muscle damage has limited their use, particularly in women who are at higher risk for heart problems because of their age or other medical issues."

The researchers said further research is needed to determine whether all women with breast cancer, including younger women and those with low cardiovascular risk, should be prescribed statins when undergoing chemotherapy that can damage the heart.

For now, women with breast cancer who meet the guidelines for taking a statin "should ideally continue taking it throughout their chemotherapy treatment," said Abdel-Qadir, who also is a cardiologist at Women's College Hospital and the Peter Munk Cardiac Centre in Toronto.

"Women who do not have an indication for a statin should ask their health care team if they can join a clinical trial studying the benefits of statins in protecting against heart muscle damage during chemotherapy," he said. "Otherwise, they should focus on measures to optimize their cardiovascular health before, during and after chemotherapy."

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