Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Int J Cardiol. 2023 Nov 15;391:131219. doi: 10.1016/j.ijcard.2023.131219. Epub 2023 Jul 30.
Cardiotoxicity occurs in 5-20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines.
PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed.
On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33-0.83, P = 0.01; I = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66-3.1, P < 0.01; I = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 - +4.79, P = 0.05; I = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF.
The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
接受蒽环类药物治疗的癌症患者中有 5-20%会发生心脏毒性。本研究的目的是汇总所有研究他汀类药物在接受蒽环类药物治疗的患者中心脏保护作用的随机对照试验（RCT）。
截至 2023 年 5 月 3 日，我们在 PubMed 和 Scopus 电子数据库中搜索了合格的研究。共纳入了 5 项包含 808 名患者的 RCT。疗效终点为蒽环类药物介导的心脏毒性发生率、心力衰竭（HF）住院率、蒽环类药物治疗后左心室射血分数（LVEF）值以及计算为蒽环类药物治疗前后 LVEF 差值的 ∆LVEF。还评估了安全性终点[即肌肉疼痛和严重不良事件（SAE）的发生率]。
在汇总分析中，与安慰剂组相比，他汀类药物治疗组的心脏毒性发生率较低[风险比（RR）0.52，95%置信区间（CI）0.33-0.83，P=0.01；I=0%]，LVEF 均值较高[平均差异（MD）1.88，95%CI 0.66-3.1，P<0.01；I=57.3%]，随访期间的 ∆LVEF 更有利（MD 2.38，95%CI -0.03 - +4.79，P=0.05；I=99%），尽管 HF 住院率和不良事件发生率无显著差异。值得注意的是，严重的异质性影响了 LVEF 和 ∆LVEF 的分析。
目前对迄今为止进行的所有 RCT 的荟萃分析显示，他汀类药物对蒽环类药物引起的心脏毒性和 LVEF 保护的风险具有总体有益作用。HF 住院率无差异。需要更多的大型 RCT 来充分研究他汀类药物对接受蒽环类药物治疗的患者预后的影响。
