Adjunctive atorvastatin reduces cardiac dysfunction in patients with anthracycline-treated lymphoma

Adjunctive therapy with atorvastatin appears to reduce the proportion of patients with lymphoma who are being treated with anthracyclines and who also develop cardiac dysfunction.

The findings were published on August 8, 2023 in JAMA/Journal of the American Medical Association.

“Anthracyclines treat a broad range of cancers. Basic and retrospective clinical data have suggested that use of atorvastatin may be associated with a reduction in cardiac dysfunction due to anthracycline use, the authors said. [The objective of this study was] to test whether atorvastatin is associated with a reduction in the proportion of patients with lymphoma receiving anthracyclines who develop cardiac dysfunction.”

The randomized clinical trial was conducted at medical centers in the US and Canada where investigators enrolled 300 subjects with lymphoma who were scheduled to receive anthracycline-based chemotherapy.

Enrollment took place between January 25, 2017, and September 10, 2021, with final follow-up on October 10, 2022.

The researchers randomized the subjects to treatment with atorvastatin, 40 mg/d (n = 150) or placebo (n = 150) for 12 months.

The primary outcome was the proportion of subjects with an absolute decline in left ventricular ejection fraction (LVEF) of 10% from prior to chemotherapy to a final value of <55% over 12 months.  A secondary outcome was the proportion of subjects with an absolute decline in LVEF of 5% from prior to chemotherapy to a final value of < 55% over 12 months.

Of the 300 randomized subjects, 286 completed the trial.

For the entire study group, the baseline mean LVEF was 63% and the follow-up LVEF was 58%.

At 12-month follow-up, 46 subjects (15%) had a decline in LVEF of 10% or greater from prior to chemotherapy to a final value of less than 55%.

The incidence of the primary end point was 9% (13/150) in the atorvastatin group and 22% (33/150) in the placebo group (P = .002).

The odds of a 10% or greater decline in LVEF to a final value of less than 55% after anthracycline treatment was almost 3 times greater for participants randomized to placebo compared with those randomized to atorvastatin.

Compared with placebo, atorvastatin treatment also significantly  reduced the incidence of the secondary end point (13% vs 29%; P = .001).

The number of serious related adverse events was low and similar between groups.

The authors concluded, “Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction. This finding may support the use of atorvastatin in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline use.”