G'day, it's Warrick Bishop here and welcome to my podcast and videocast station. As always, I really do appreciate you taking the time to tune in and listen and I hope that I'm able to put something together that you find informative and valuable for your own best health journey. Today I'd like to talk about an area of statin therapy that, well, most of us probably haven't even thought of. And this goes against the grain of statin bashing. I'm going to talk about using statins in a completely different area. And the area is in association with chemotherapy being given to try and reduce progression of heart failure. It's a really interesting space. There is indeed a trial that has been done called STOP-CA, and that stands for statins to prevent the cutout toxicity associated with anthracyclines. Well, that's a bit of a mouthful, but you can use S for statins, T-O for two. P for prevent for stop, CA, cardiotoxicity anthracycline. So it's an abbreviation using that title. The concept behind the trial was to run a double-blind placebo-controlled multi-center trial to try and test the effectiveness of atorvostatin versus placebo on the occurrence of cardiac dysfunction in patients with lymphoma. What we know is that patients with these sort of lymphoma type cancers need very cardiotoxic medication to treat the cancer. These agents bear high risk of damaging the heart. And we know that there's a 10 to 15 fold increase, which is significant when increased risk of heart failure when it comes to using. anthracycline. So this treatment of a cancer is not without risk of its own. Well, interestingly, there's been some retrospective and observational data that raised the question, could statins be useful in protecting the heart from anthracycline therapy, or these powerful chemotherapeutic agents? So some experimental data, some retrospective data, but a fairly recent multicenter randomized trial showed no change at all in the placebo versus torvostatin group in terms of progression to cardiac failure. So the STOP-CA study was really all about trying to, well, I guess answer this question once and for all with... specific and directed clarity and giving us an opportunity to know as best as possible what to advise people in this space. So the inclusion criteria for STOP-CA was that the individuals had to have Hodgkin's or non-Hodgkin's lymphoma. They needed to be scheduled for receiving anthracycline therapy. and they needed to be 18 years of age or older. They needed to have exclusion criteria, so you couldn't go in the study if you were meant to have statin therapy. You couldn't be included in the study if you had pregnancy or you were breastfeeding. Obviously, you needed to be able to provide consent, and there was a number of other exclusions too. allowed people into that trial. So they did try and keep it as clean as possible. The idea was to try and evaluate who would have a reduction in the pumping capacity of the heart by 10% or more. There was a secondary outcome, which meant they would also be following people and trying to evaluate if there was a reduction in the pumping capacity or the left ventricular ejection fraction of the heart of less than 5%. So a very interesting study and one that was left field in terms of where I normally think of statins myself. Well, they ran the study for 12 months and they had, when they looked at the primary endpoint, which is people having a reduction in their function of 10% or more. And we normally think of a normal ejection fraction around 60%. So this is an ejection fraction going from 60 odd percent in a normal heart down to about 50%. So when they looked at that over a six month period, 9% of the study participants in the statin treated group had a reduction consistent with the endpoint observation, but 20%. 2% in the placebo group, so more than twice as many. When they looked at this, this was really very compelling, and it turned out that it was two to three times greater the chance of having progression to reduction of left ventricular function to a significant degree in the placebo-controlled group compared to the atorvastatin or statin group. an amazing outcome and one that I wouldn't have normally been aware of. Stop CA, a study to look at whether lowering, well, using statin therapy. in individuals receiving chemotherapy could make a difference and amazingly it does. Why? Some of the theories behind that are related to inflammatory mediated responses of the cells and some of the positive effects that statins are believed to potentially have in terms of mitigating inflammatory change. Incredibly interesting space. Could it be useful? Well, of course, if you or someone you know is going through a chemotherapeutic process, maybe it's a... point of conversation with the treating doctors. Similarly, if you're someone who is on a statin already and needs to be considered for chemotherapy, then it might be prudent to remain on that statin therapy, or at least again, have the conversation about do you stay on it or not, depending on what your specialist advises. Well, I hope you found that interesting. I really do. I think it's a very interesting spot and certainly one that wasn't on my radar until it popped up. For now, I am going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now.
