The Efficiency of Statins in the Protection of Anthracycline- Induced Cardiomyopathy. A Randomized Control Study from Egypt

Background: Antineoplastic agents of the anthracycline (ANT) group are used
in many forms of malignancies. They might lead to irreversible cardiomyopathy
(CMP). Statins can reduce the risk of ANT-induced cardiotoxicity through their
significant pleiotropic effects, antioxidative and anti-inflammatory properties.
Aim of work: To evaluate whether (Simvastatin in dose 40 mg) verses (low
dose Simvastatin 10 mg +Ezetimibe 10 mg) could protect cardiotoxicity of ANT
which could lead to ANT induced cardiomyopathy.
Methodology: Total 105 female breast cancer patients, mean age of 50.7+ 8
years who had ANT chemotherapy were enrolled. They were randomized into
(Simvastatin in dose 40 mg) 30 patients, (low dose Simvastatin 10 mg +
Ezetimibe 10 mg) 30 patients and ANT control group 45 patients. The study
done between Jan 2018 to Jan 2020 in Clinical Oncology Department, Aswan
University in Egypt. The therapy continued for 6 months. Evaluate the mean
decline difference of the left ventricular ejection fraction (LVEF) at beginning
of ANT chemotherapy then after ending of 4 cycles.
Results: The mean decline difference in Left ventricular ejection fraction
(LVEF) was statistically significant among (Simvastatin40mg) group to
Anthracycline control group P< 0.001 (6.67 ± 4.02% vs 9.22 ± 3.77). No
statistically significant differences between (Simvastatin10mg with Ezetimibe
10 mg) group and ANT control group P= 0.08 (7.33 ± 4.12% vs 9.22 ± 3.77) or
between Simvastatin group and Simvastatin with Ezetimibe group (6.67 ± 4.02
vs. 7.33 ± 4.12%; P= 0.08). The percentage of decline > 10% of the LVEF after
6 months in 3 studied groups was statistically significantly lower among both
(Simvastatin 40mg group) and (Simvastatin10mg with Ezetimibe 10mg) group
(20%) in comparison to ANT control group (46.7%), P= 0.01.
Conclusions: The statins do exert protective cardiovascular effects not solely
from their lipid-lowering capacity but also from their anti-inflammatory effect.
The dose of the statin plays a crucial rule in cardioprotective properties in ANT
chemotherapy.