HMG-CoA-reductase inhibitors added-on standard therapy may lower the risk for incident left ventricular dysfunction +/- heart failure in Epirubicin recipients with gastric cancer

Introduction: Despite the prolonged cancer-related survival in patients (pts) treated with anthracyclines, the treatment related cardiotoxicity remains a major concern. Even though there are some experimental and clinical evidences supporting HMG-CoA-reductase inhibitors (statins) in anthracycline induced cardiotoxicity with doxorubicin (adriamicin), the literature is still poor with data about epirubicin (farmorubicin), another anthracycline, in this clinical setting. The goal of this study was to evaluate the effect of continuous statin treatment (CST) on new-onset left ventricular dysfunction (LVD) +/- heart failure (HF) in pts with gastric cancer (GC) treated with epirubicin. Methods: We analysed retrospectively starting with 1st of January, 2005, a number of 432 adult pts newly diagnosed with GC, confirmed by biopsy, who underwent anthracycline based chemotherapy with epirubicin standard doses. The study group had 144 pts and received CST for current indications. Their counterparts did not receive CST. The date of the GC confirmatory diagnosis was considered the study enter date. Demographically: medium age 57.5 +/-11.2 years, male gender predominance 72.3%. The primary outcome was incident LVD +/- HF, and the follow-up period 2.55 +/- 1.68 years. Results: After propensity matching (1:2) the 144 pts receiving CST were combined with 288 controls. The new onset LVD was diagnosed in 94 pts, 25 in CST group vs 69 in their counterparts, including 33 pts with incident HF, 7 in CST group and 26 in their counterparts. The proportions in the 2 groups were 4.8611 and 9.0277, and the dispersion 0.046248, and, respectively, 0.082127. Inside the study group, 77 pts received rosuvastatin, 52 pts atorvastatin, and 15 pts other statin. We did not find any significant differences among different statins; we also did not find any statistical diff erences between genders. Asymptomatic LVD was found in 61 pts, 18 in CST group, 43 in their counterparts. Conclusions: In our study, add-on therapy with statin was associated with lower risk for incident LVD +/- HF in pts with GC treated with epirubicin. This appears as a class effect of statins. This finding warrants for further prospective investigation. Since the mechanism of anthracycline cardiotoxicity looks like being correlated with oxygen free radicals, the pleiotropic effects of statins may mitigate cardiotoxicity.

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