Table 3.
Summary of randomized controlled trials of statins to prevent anthracycline mediated CTRCD
| Author/Year/Imaging Technique | n | Cancer | Intervention | CTRCD | Statin | Placebo | Statin/Placebo difference |
|---|---|---|---|---|---|---|---|
| Acar et al. 2011 (echo)12 | 40 | Hematological Malignancies | Atorvastatin 40 mg (6 months) | LVEF < 50%(1/20 in statin, 5/20 in control, p = 0.18) | Baseline 61.3 ± 7.9%Post 62.6 ± 9.3%Diff + 1.3 ± 3.8% | Baseline 62.9 ± 7.0%Post 55.0 ± 9.5%Diff: −7.9 ± 8.0% | p < 0.001 |
| Nabati et al. 2019 (echo)13 | 89* | Breast Cancer | Rosuvastatin 20 mg (6 months) | LVEF < 45%(4/38 in statin, 6/39 in placebo), p = 0.963 | Baseline 55.1 ± 4.8%Post: 53.5 ± 6.7%Diff −1.5 ± 6.6 | Baseline 55.1 ± 5.1% Post 50.0 ± 6.6%Diff −5.2 ± 0.7% | p = 0.012 |
| Hundley et al. 2022 (CMR)16 | 279# | Breast and Hematological Malignancies | Atorvastatin 40 mg (24 months) | LVEF < 50%(4/100 in statin, 7/105 in placebo, no p-value) | Baseline 62.6 ± 6.4%Post: 57.7 ± 5.6%Diff 3.2 ± 0.7% | Baseline 61.7 ± 5.5%Post: 57.4 ± 6.8%Diff 3.3 ± 0.6% | p = 0.93 |
| Thavendiranathan et al. (CMR)—current study | 112 | Breast, Heme, Others | Atorvastatin 40 mg (2.5 months) | LVEF < 50%(3/53 in statin, 5/55 in placebo) | Baseline 60.2 ± 0.4%Post: 57.3 ± 5.8% | Baseline 59.2 ± 6.6%Post: 55.9 ± 7.4% | p = 0.34 |
| Overall | 520 | Statin 12/211Placebo 23/219 (p = 0.068 or 0.10 with Yates correction)‡ | OR 0.53 (0.25–1.10), p = 0.089‡ |
CTRCD, cancer therapy related cardiac dysfunction; Diff, difference; CMR, cardiovascular magnetic resonance; echo, echocardiogram; CTRCD, cancer therapy related cardiac dysfunction; OR, odds ratio *although 89 recruited, final follow-up only in 77 (39 placebo, 38 statin); #Although 279 recruited 2-year follow up only available in 205 (105 placebo, 100 statin). ‡We performed a meta-analysis using the Cochran–Mantel–Haenszel (CMH) method to estimate the pooled odds-ratio across the 4 RCTs using a random effect model) and evaluating the between-arm differences in the proportion with CTRCD with the CMH χ2 test, the OR [95% CI] was 0.51 [0.25, 1.05], P = 0.095 (see Supplementary material online Fig. S7 for forest plot).