Statin therapy and anthracycline-related cardiac dysfunction: a meta-analysis of randomized clinical trials

Figures & data

Table 1. Characteristics of the studies included in the meta-analysis.

Study (year)	Daily regimen of statins	Cancer therapy	Cardiotoxicity definition	Population characteristics	Follow-up	Risk of bias
Acar (2011)	Atorvastatin 40 mg	Adriamycin or idarubicin Mean cumulative adriamycin dose: 261.4.and 251.1 mg/m^2a Mean cumulative idarubicin dose: 262.5.and 330.0 mg/m^2a Vincristine: 90% and 95%^a Cyclophosphamide: 80% and 85%^a	LVEF impairment defined as EF <50%. (echocardiogram)	Patients with non-Hodgkin’s lymphoma or multiple myeloma leukemia. Mean age: 49.2 (11.2) years, 42.5% male	6 months	Some concerns
Nabati (2019)	Rosuvastatin 20 mg	Anthracycline and cyclophosphamide Mean cumulative anthracycline dose: 339.4 and 337.8 mg/m^2a Trastuzumab: 15.8% and 10.3%^a	Reduction in LVEF from 5% to <55% with associated signs or symptoms of HF, or a reduction in LVEF from 10% to <55% without accompanying signs or symptoms (echocardiogram)	Women with breast cancer Mean age: 49.2 (11.2) years	6 months	Low
Hundley (2022)	Atorvastatin 40 mg	Doxorubicin Median cumulative anthracycline dose: 240 mg/m^2 HER2 inhibitor taken before trial; 2.9% and 5%^a	LVEF impairment defined as EF <50% (Cardiac magnetic resonance)	Patients with breast cancer or lymphoma. Mean age: 49 (12) years, 92% female	24 months	Low
STOP-CA (2023)	Atorvastatin 40 mg	Anthracycline. Mean cumulative anthracycline dose: 300 m^2a	Decline in LVEF of ≥10% to an EF <55% (echocardiogram)	Patients with lymphoma (Hodgkin and non-Hodgkin) Median age 52 years, 47% female	12 months	Not calculated

EF: ejection fraction; HF: heart failure; LVEF: left ventricular ejection fraction.

^aIn statin and placebo groups, respectively.

Figure 1. Effect of statin on the incidence of cardiotoxicity based on the decrease in LVEF. Fixed effects model, odds ratio, 95% confidence interval (CI), and I² statistics.

Figure 2. Sensitivity analysis. Results of the meta-analysis by excluding in each step one of the studies included in the review.

Data availability statement

The data that support the findings of this study are available from the corresponding author, W.M, upon reasonable request.