Effect of Atorvastatin on Cardiac Dysfunction in Patients Receiving Anthracyclines for Lymphoma

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In a study (STOP-CA) reported in JAMA, Neilan et al found that atorvastatin reduced the risk of decreased left ventricular ejection fraction (LVEF) in patients receiving anthracycline-based chemotherapy for the treatment of lymphoma.

Study Details

In the U.S.-Canadian double-blind trial, 300 patients with lymphoma scheduled to receive anthracycline-based chemotherapy were randomly assigned between January 2017 and September 2021 to receive atorvastatin at 40 mg/d (n = 150) or placebo (n = 150) for 12 months. Among the 300 patients, 220 had non-Hodgkin lymphoma and 80 had Hodgkin lymphoma. The primary outcome measure was the proportion of patients with an absolute decline in LVEF of ≥ 10% from prior to chemotherapy to a final value of < 55% at 12 months.

Key Findings

In the total population, the baseline mean LVEF was 63% (standard deviation [SD] = 4.6%) and mean LVEF at 12 months was 58% (SD = 5.7%). At 12 months, a decline in LVEF ≥10% to a final value < 55% was observed in 13 patients (9%) in the atorvastatin group vs 33 (22%) in the placebo group (odds ratio = 2.9, 95% confidence interval [CI] =1.4–6.4). The atorvastatin group also had a significantly reduced incidence of the secondary outcome measure of absolute decline in LVEF ≥ 5% from prior to chemotherapy to a final value < 55% (13% vs 29%, P = .001).

During 24 months of follow-up, adjudicated heart failure events occurred in four patients (3%) in the atorvastatin group and nine patients (6%) in the placebo group (P = .26). Over 12 months, muscle pain was observed in 19% vs 14% of patients, with no cases of myositis observed. Kidney failure occurred in two patients vs four patients.

The investigators concluded: “Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction. This finding may support the use of atorvastatin in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline use.”

Tomas G. Neilan, MD, MPH, of the Cardio-oncology Program and Cardiovascular Imaging Research Center, Massachusetts General Hospital, is the corresponding author for the JAMA article.

Disclosure: The study was supported by the National Heart, Lung, and Blood Institute and others. For full disclosures of the study authors, visit

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