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Do Statins Lower the Risk of Cardiovascular Complications in Patients Treated With Radiotherapy to the Chest, Neck, or Head?

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Key Points

  • The researchers found that the use of statins was associated with a 32% reduction in stroke.
  • There was also a strong trend toward reduction in overall cardiovascular events, such as heart attacks and stroke, and death due to those cardiovascular events, although the authors said the 15% reduction they found was not statistically significant due to the high-risk population of patients in the study.
  • The crude event rate was 10.31% for patients not using statins and 9.03% for statin users over a mean time to event/censoring of 534±687 days for nonusers and 594±706 days for the statin users.

Patients with cancer who took cholesterol-lowering statin medication following radiation therapy of the chest, neck, or head had significantly reduced risk of suffering a stroke—and possibly other cardiovascular complications—according to research published by Boulet et al in the Journal of the American Heart Association.

Radiation therapy can cause side effects include scarring or thickening of arteries, and over time that can lead to blockages that cause heart attack and stroke. In fact, the authors point out that cardiovascular disease is the leading cause of illness and death among cancer survivors.

Methods

The retrospective cohort study looked at whether statin medication, which reduces the formation of plaques that block blood vessels, might lower the risk of cardiovascular and cerebrovascular disease after radiation therapy to the chest, neck, or head. Researchers studied data from 5,718 cardiac patients over age 65 (with a mean age of 75) at McGill University Health Centre in Montreal, Canada, who had undergone radiation therapy for chest, head, or neck cancer from 2000 to 2011. The majority—4,166 patients—were taking statins. Most of the people in the study had underlying cardiovascular disease.

Findings

The researchers found that the use of statins was associated with a 32% reduction in stroke (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.48–0.98, P = .0368). There was also a strong trend toward reduction in overall cardiovascular events, such as heart attacks and stroke, and death due to those cardiovascular events, although the authors said the 15% reduction they found was not statistically significant due to the high-risk population of patients in the study. The crude event rate was 10.31% for patients not using statins and 9.03% for statin users (HR = 0.92, 95% CI 0.76–1.10, P = .3451]) over a mean time to event/censoring of 534±687 days for nonusers and 594±706 days for the statin users.

“Statins decrease cholesterol levels and have anti-inflammatory properties. Multiple studies have revealed the beneficial effects of statin therapy on reducing the risks of vascular disease in a variety of populations,” said study author Negar Mousavi, MD, MHSc, of McGill University Health Center. “Statins are protective in patients with heart disease, previous strokes, and with high cholesterol levels.”

“Our study demonstrated that statin therapy could be favorable even with the competing risks of cancer and cancer-related mortality in patients who received radiation therapy,” continued Dr. Mousavi. “No other agent is recommended with enough evidence to reduce the risk of vascular events among [patients with] cancer receiving radiation to the head, neck, or chest.”

However, the authors pointed out that there is a need for prospective studies to explore the role of statins after radiation therapy in wider populations, and to establish definitive guidelines on the management of radiation-induced vascular disease.

Disclosure: For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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