Medicines

Cardioprotective agents underused in cancer patients


Cardioprotective therapies such as statins and antiplatelet agents are underutilised in patients with cancer, an Australian study has shown.

A retrospective review of medical records of 320 patients admitted to the cardiology unit at John Hunter Hospital in 2018 and 2019 found that patients with a history of cancer who had an indication for cardioprotective medication were significantly less likely to be prescribed them compared to patients without cancer.

Of the 69 cancer patients, 36% had established cardiovascular disease prior to their cancer diagnosis, while 64% developed cardiovascular disease after their cancer diagnosis.

Compared to patient s without a history of cancer, those with cancer were less likely to be on a statin (OR: 0.41; 95% CI: 0.22 to 0.77; p = 0.006) and antiplatelet therapies  (OR: 0.53; 95% CI: 0.29 to 1.00; p = 0.049)

There were also lower rates of ACE inhibitor or ARB and beta-blocker use, although these were not significant (p = 0.405 and p = 0.243, respectively)

The differences in cardioprotective medication use were seen despite patients in both groups having similar cardiovascular risk profiles.

In multivariable models after adjusting for confounders cancer patients were 57% less likely to have prescriptions for antiplatelet agents and statins were similarly lower in patients with CaHx (OR: 0.43) and 62% less likely to have prescription for a statin (OR: 0.38) compared to people without cancer

Cancer patients were also more likely to have been admitted to the hospital for heart failure.

Study author Dr Doan Ngo (PhD) of the University of Newcastle said the findings were of concern given that a history of cancer and cancer treatment is associated with an increased risk of cardiovascular disease.

“While a major focus of cardio-oncology research has been on cancer therapy–induced cardiotoxicity, optimisation of cardiac care in patients with [cancer history] as not been widely addressed,” he said.

“It is clear there are practice and policy gaps regarding the treatment of these patients and it is vital to develop strategies to improve guideline-directed cardioprotective therapies in cardio-oncology.”

The findings are  published in JACC: CardioOncology.

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