Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study
Background Statins are hypothesized to reduce the risk of cardiotoxicity associated with anthracyclines and trastuzumab. Our aim was to study the association of statin exposure with hospitalization or emergency department visits (hospital presentations) for heart failure (HF) after anthracycline‐ an...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.018393 |
| _version_ | 1818312171765891072 |
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| author | Husam Abdel‐Qadir David Bobrowski Limei Zhou Peter C. Austin Oscar Calvillo‐Argüelles Eitan Amir Douglas S. Lee Paaladinesh Thavendiranathan |
| author_facet | Husam Abdel‐Qadir David Bobrowski Limei Zhou Peter C. Austin Oscar Calvillo‐Argüelles Eitan Amir Douglas S. Lee Paaladinesh Thavendiranathan |
| author_sort | Husam Abdel‐Qadir |
| collection | DOAJ |
| description | Background Statins are hypothesized to reduce the risk of cardiotoxicity associated with anthracyclines and trastuzumab. Our aim was to study the association of statin exposure with hospitalization or emergency department visits (hospital presentations) for heart failure (HF) after anthracycline‐ and/or trastuzumab‐containing chemotherapy for early breast cancer. Methods and Results Using linked administrative databases, we conducted a retrospective cohort study of women aged ≥66 years without prior HF who received anthracyclines or trastuzumab for newly diagnosed early breast cancer in Ontario between 2007 to 2017. Statin‐exposed and unexposed women were matched 1:1 using propensity scores. Trastuzumab‐treated women were also matched on anthracycline exposure. We matched 666 statin‐discordant pairs of anthracycline‐treated women and 390 pairs of trastuzumab‐treated women (median age, 69 and 71 years, respectively). The 5‐year cumulative incidence of HF hospital presentations after anthracyclines was 1.2% (95% CI, 0.5%–2.6%) in statin‐exposed women and 2.9% (95% CI, 1.7%–4.6%) in unexposed women (P value, 0.01). The cause‐specific hazard ratio associated with statins in the anthracycline cohort was 0.45 (95% CI, 0.24–0.85; P value, 0.01). After trastuzumab, the 5‐year cumulative incidence of HF hospital presentations was 2.7% (95% CI, 1.2%–5.2%) in statin‐exposed women and 3.7% (95% CI, 2.0%–6.2%) in unexposed women (P value 0.09). The cause‐specific hazard ratio associated with statins in the trastuzumab cohort was 0.46 (95% CI, 0.20–1.07; P value, 0.07). Conclusions Statin‐exposed women had a lower risk of HF hospital presentations after early breast cancer chemotherapy involving anthracyclines, with non‐significant trends towards lower risk following trastuzumab. These findings support the development of randomized controlled trials of statins for prevention of cardiotoxicity. |
| first_indexed | 2024-12-13T08:13:37Z |
| format | Article |
| id | doaj.art-65547d0122084c479282e30be79db723 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:13:37Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-65547d0122084c479282e30be79db7232022-12-21T23:54:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-01-0110210.1161/JAHA.119.018393Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort StudyHusam Abdel‐Qadir0David Bobrowski1Limei Zhou2Peter C. Austin3Oscar Calvillo‐Argüelles4Eitan Amir5Douglas S. Lee6Paaladinesh Thavendiranathan7Division of Cardiology and Department of Medicine Women's College Hospital Toronto Ontario CanadaDivision of Cardiology and Department of Medicine Women's College Hospital Toronto Ontario CanadaICES (formerly the Institute for Clinical Evaluative Sciences) Toronto Ontario CanadaICES (formerly the Institute for Clinical Evaluative Sciences) Toronto Ontario CanadaTed Rogers Centre for Heart Research and the Division of Cardiology Peter Munk Cardiac CenterUniversity Health Network Toronto Ontario CanadaInstitute of Health Policy Management and EvaluationUniversity of Toronto Ontario CanadaTed Rogers Centre for Heart Research and the Division of Cardiology Peter Munk Cardiac CenterUniversity Health Network Toronto Ontario CanadaTed Rogers Centre for Heart Research and the Division of Cardiology Peter Munk Cardiac CenterUniversity Health Network Toronto Ontario CanadaBackground Statins are hypothesized to reduce the risk of cardiotoxicity associated with anthracyclines and trastuzumab. Our aim was to study the association of statin exposure with hospitalization or emergency department visits (hospital presentations) for heart failure (HF) after anthracycline‐ and/or trastuzumab‐containing chemotherapy for early breast cancer. Methods and Results Using linked administrative databases, we conducted a retrospective cohort study of women aged ≥66 years without prior HF who received anthracyclines or trastuzumab for newly diagnosed early breast cancer in Ontario between 2007 to 2017. Statin‐exposed and unexposed women were matched 1:1 using propensity scores. Trastuzumab‐treated women were also matched on anthracycline exposure. We matched 666 statin‐discordant pairs of anthracycline‐treated women and 390 pairs of trastuzumab‐treated women (median age, 69 and 71 years, respectively). The 5‐year cumulative incidence of HF hospital presentations after anthracyclines was 1.2% (95% CI, 0.5%–2.6%) in statin‐exposed women and 2.9% (95% CI, 1.7%–4.6%) in unexposed women (P value, 0.01). The cause‐specific hazard ratio associated with statins in the anthracycline cohort was 0.45 (95% CI, 0.24–0.85; P value, 0.01). After trastuzumab, the 5‐year cumulative incidence of HF hospital presentations was 2.7% (95% CI, 1.2%–5.2%) in statin‐exposed women and 3.7% (95% CI, 2.0%–6.2%) in unexposed women (P value 0.09). The cause‐specific hazard ratio associated with statins in the trastuzumab cohort was 0.46 (95% CI, 0.20–1.07; P value, 0.07). Conclusions Statin‐exposed women had a lower risk of HF hospital presentations after early breast cancer chemotherapy involving anthracyclines, with non‐significant trends towards lower risk following trastuzumab. These findings support the development of randomized controlled trials of statins for prevention of cardiotoxicity.https://www.ahajournals.org/doi/10.1161/JAHA.119.018393anthracyclinecardiotoxicityheart failurestatintrastuzumab |
| spellingShingle | Husam Abdel‐Qadir David Bobrowski Limei Zhou Peter C. Austin Oscar Calvillo‐Argüelles Eitan Amir Douglas S. Lee Paaladinesh Thavendiranathan Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anthracycline cardiotoxicity heart failure statin trastuzumab |
| title | Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study |
| title_full | Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study |
| title_fullStr | Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study |
| title_full_unstemmed | Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study |
| title_short | Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study |
| title_sort | statin exposure and risk of heart failure after anthracycline or trastuzumab based chemotherapy for early breast cancer a propensity score matched cohort study |
| topic | anthracycline cardiotoxicity heart failure statin trastuzumab |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.018393 |
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