Effect of Statin Therapy on the Risk for Incident Heart Failure in Patients With Breast Cancer Receiving Anthracycline Chemotherapy An Observational Clinical Cohort Study

Objectives The aim of this study was to evaluate the effect of continuous statin treatment on new-onset heart failure (HF) in patients with breast cancer receiving anthracycline-based chemotherapy. Background In vitro and animal model experimental studies have reported that statins prevent doxorubicin-induced cardiotoxicity. Methods A total of 628 women with newly diagnosed breast cancer (mean age 51.5 +/- 10.8 years) treated with anthracycline were retrospectively identified and studied. The primary outcome (incident HF hospitalization) was compared in propensity-matched patients receiving uninterrupted statin therapy through the follow-up period of 2.55 +/- 1.68 years and their counterparts not receiving continuous statin therapy. Results After propensity matching (2:1), the 67 patients (10.7%) receiving uninterrupted statin therapy were combined with 134 controls. New-onset HF was observed in 67 of the 201 matched patients. Multivariate-matched Cox regression analysis showed a significantly lower hazard ratio [HR] of 0.3 (95% confidence interval [CI]: 0.1 to 0.9; p = 0.03) for patients taking uninterrupted statin therapy. Cardiotoxicity risk factors at the time of cancer diagnosis (HR: 5.0; 95% CI: 2.2 to 11.1; p < 0.001), baseline ejection fraction <55% (HR: 2.7; 95% CI: 1.2 to 6.3; p = 0.02), and trastuzumab use (HR: 3.0; 95% CI: 1.3 to 7.2; p = 0.01) were predictors of incident HF. Conclusions In this analysis of female patients with breast cancer treated with anthracycline chemotherapy, statin use was associated with a lower risk for incident HF. This finding is consistent with prior animal studies and warrants further investigation through prospective randomized clinical trials. (J Am Coll Cardiol 2012;60:2384-90) (C) 2012 by the American College of Cardiology Foundation