Atorvastatin for Anthracycline-Associated Cardiac Dysfunction

• DOI: 10.1001/jama.2023.11887
• Publication Date: 2023-08-08T15:18:59Z
• Authors: Tomas G. Neilan; Thiago Quinaglia; Takeshi Onoue; Syed S. Mahmood; Zsofia D. Drobni; Hannah K. Gilman; Amanda Smith; Julius C. Heemelaar; Priya Brahmbhatt; Jor Sam Ho; Supraja Sama; Jakub Svoboda; Donna S. Neuberg; Jeremy S. Abramson; Ephraim P. Hochberg; Jefferey A. Barnes; Philippe Armand; Eric D. Jacobsen; Caron A. Jacobson; Austin I. Kim; Jacob D. Soumerai; Yuchi Han; Robb S. Friedman; Ann S. Lacasce; Bonnie Ky; Dan Landsburg; Sunita Nasta; Raymond Y. Kwong; Michael Jerosch-H...; Robert A. Redd; Lanqi Hua; James L. Januzzi; Aarti Asnani; Negareh Mousavi; Marielle Scherrer...
• Keywords: Heart Failure; Male; Adult; Antibiotics, Antineoplastic; Lymphoma; Heart Diseases; Stroke Volume; Cardiovascular Agents; Middle Aged; 16. Peace & justice; Ventricular Function, Left; 3. Good health; Double-Blind Method; Atorvastatin; Humans; Female; Anthracyclines; Retrospective Studies; Follow-Up Studies; Aged

Importance Anthracyclines treat a broad range of cancers. Basic and retrospective clinical data have suggested that use atorvastatin may be associated with reduction in cardiac dysfunction due to anthracycline use. Objective To test whether is the proportion patients lymphoma receiving anthracyclines who develop dysfunction. Design, Setting, Participants Double-blind randomized trial conducted at 9 academic medical centers US Canada among 300 were scheduled receive anthracycline-based chemotherapy. Enrollment occurred between January 25, 2017, September 10, 2021, final follow-up on October 2022. Interventions atorvastatin, 40 mg/d (n = 150), or placebo 150) for 12 months. Main Outcomes Measures The primary outcome was participants an absolute decline left ventricular ejection fraction (LVEF) ≥10% from prior chemotherapy value <55% over A secondary LVEF ≥5% Results Of (mean age, 50 [SD, 17] years; 142 women [47%]), 286 (95%) completed trial. Among entire cohort, baseline mean 63% (SD, 4.6%) 58% 5.7%). Study drug adherence noted 91% participants. At 12-month follow-up, 46 (15%) had 10% greater less than 55%. incidence end point 9% (13/150) group 22% (33/150) ( P .002). odds 55% after treatment almost 3 times compared those (odds ratio, 2.9; 95% CI, 1.4-6.4). Compared placebo, also reduced (13% vs 29%; .001). There 13 adjudicated heart failure events (4%) 24 months follow-up. no difference rates incident study groups (3% 6% placebo; .26). number serious related adverse low similar groups. Conclusions Relevance treated chemotherapy, This finding support high risk Trial Registration ClinicalTrials.gov Identifier: NCT02943590