Lee John, Tan Sean, Ramkumar Satish
Victorian Heart Institute, Monash University, Melbourne, VIC, Australia.
Victorian Heart Hospital, Monash Health, 631 Blackburn Road Clayton VIC, Melbourne, VIC, 3168, Australia.
Cardiooncology. 2024 Dec 18;10(1):88. doi: 10.1186/s40959-024-00292-4.
Despite advanced in targeted cancer therapies, anthracyclines remain essential in treating various malignancies, albeit with risks of cancer therapy-related cardiac dysfunction (CTRCD). Out of the myriad of mitigation strategies for CTRCD, statins are an attractive preventive therapy for anthracycline associated CTRCD given their widespread availability, cheap costs and added benefit of atherosclerotic cardiovascular disease (ASCVD) risk reduction. Recent trials of PREVENT, SPARE-HF, and STOP-CA investigated atorvastatin's efficacy in preventing CTRCD, with mixed outcomes. While STOP-CA showed a significant reduction in CTRCD rates (22% vs. 8% in placebo), PREVENT and SPARE-HF found no statistical differences between statin and placebo groups. The trials faced challenges such as selection bias, exclusion of patients with comorbidities, and reliance on imaging-derived outcomes, which may not reflect clinically meaningful benefits. This calls for improved trial designs that prioritize diverse patient recruitment, longer follow-ups, and clinically relevant endpoints to enhance the translational impact of findings. Addressing these challenges collaboratively between oncology and cardiology will be crucial for optimizing patient outcomes in this vulnerable population. Future studies should emphasize both immediate cardioprotective effects and long-term cardiovascular benefits of statins, especially in the context of atherosclerotic cardiovascular disease in cancer survivors.
尽管靶向癌症治疗取得了进展,但蒽环类药物在治疗各种恶性肿瘤方面仍然至关重要,尽管存在癌症治疗相关心脏功能障碍(CTRCD)的风险。在众多针对CTRCD的缓解策略中,他汀类药物是一种有吸引力的预防蒽环类药物相关CTRCD的疗法,因为它们广泛可得、成本低廉,并且具有降低动脉粥样硬化性心血管疾病(ASCVD)风险的额外益处。最近的PREVENT、SPARE-HF和STOP-CA试验研究了阿托伐他汀预防CTRCD的疗效,结果不一。虽然STOP-CA显示CTRCD发生率显著降低(安慰剂组为22%,他汀组为8%),但PREVENT和SPARE-HF发现他汀组和安慰剂组之间没有统计学差异。这些试验面临着诸如选择偏倚、排除合并症患者以及依赖影像学衍生结果等挑战,而这些结果可能无法反映临床上有意义的益处。这就需要改进试验设计,优先考虑招募多样化的患者、进行更长时间的随访以及设定与临床相关的终点,以增强研究结果的转化影响力。肿瘤学和心脏病学之间合作应对这些挑战对于优化这一脆弱人群的患者预后至关重要。未来的研究应强调他汀类药物的即时心脏保护作用和长期心血管益处,尤其是在癌症幸存者的动脉粥样硬化性心血管疾病背景下。