Contrary to previous research, a preplanned secondary analysis of the multicenter PREVENT trial, reported by W.Gregory Hundley, MD, FACC, of Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, and colleagues in JAMA Network Open,1 showed that patients with cancer undergoing anthracycline-based treatment who receive statins may not experience deterioration in cognitive function. “Within-group analyses suggested that statins may have contributed to better executive function…,” the investigators added.
Study Details
This analysis included 238 patients with stage I to IV lymphoma or stage I to III breast cancer (mean age = 49 years; more than 90% female). They were randomly assigned in a 1:1 ratio to receive a daily 40-mg dose of the statin atorvastatin (n = 118) or placebo (n = 120) before the start of doxorubicin treatment, with the regimen continued for 24 months.
The investigators evaluated attention, executive function, and verbal fluency using the Trail Making Test part A (TMT-A), TMT part B (TMT-B), and Controlled Oral Word Association Test, respectively. The time taken to complete the assessments was analyzed using a linear mixed model, whereas errors (counts) were analyzed using a generalized linear mixed model with a Poisson distribution.
Key Findings
From 6 to 24 months, the change in TMT-A scores among patients treated with statins (mean = 32.5 and 29.8 seconds, respectively) did not appear to differ from that observed in individuals who received placebo (28.4 and 27.8 seconds, respectively). The investigators reported that patients administered statins demonstrated a significant mean improvement of 10.2 seconds on the TMT-B from baseline to 24 months, whereas those who received placebo showed a nonsignificant improvement of 0.2 seconds. The time-by-treatment interaction analysis did not seem to indicate a significant difference between the groups.
During the same period, patients treated with statins and placebo exhibited mean improvements in Controlled Oral Word Association scores of 4.74 and 3.62 points, respectively. No difference was observed between the groups.
W.Gregory Hundley, MD, FACC
The investigators concluded: “While prior research has indicated that statins may negatively impact cognitive function, this preplanned secondary analysis of the PREVENT randomized clinical trial did not find a significant difference in cognitive function in participants receiving statins vs placebo while also receiving doxorubicin. The study found no evidence of statin-associated cognitive decline in primarily educated White women over 24 months after receiving anthracycline-based chemotherapy for lymphoma or breast cancer. The addition of 40 mg/day of atorvastatin was not adversely associated with attention, verbal fluency, or executive functions compared with placebo. Notably, within-group analyses suggested that statins may contribute to heightened scores on tests measuring executive function. Future studies are needed to determine whether statin administration preserves cognitive function during and after receipt of anthracycline-based chemotherapy for other forms of cancer,” they added.
DISCLOSURE: The study was funded by grants from the Alliance for Clinical Trials in Oncology National Cancer Institute Community Oncology Research Program (NCORP) Research Base, Wake Forest NCORP Research Base, Eastern Cooperative Oncology Group–American College of Radiology Imaging Network NCORP Research Group, and the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
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