Statin use for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in breast cancer (BC) patients (pts).

person John W. Melson Tufts Medical Center, Boston, MA info_outline John W. Melson, Benjamin Koethe, Sharanya Mohanty, Seda Babroudi, Chen Bao, Amar Chunduru, Henry Dwaah, Matthew Finn, Annika Jain, Mumtu Lalla, Paras Patnaik, Rachael Studley, Rachel J. Buchsbaum, Kathryn Huber, Susan K. Parsons, Jenica N Upshaw

Authors person John W. Melson Tufts Medical Center, Boston, MA info_outline John W. Melson, Benjamin Koethe, Sharanya Mohanty, Seda Babroudi, Chen Bao, Amar Chunduru, Henry Dwaah, Matthew Finn, Annika Jain, Mumtu Lalla, Paras Patnaik, Rachael Studley, Rachel J. Buchsbaum, Kathryn Huber, Susan K. Parsons, Jenica N Upshaw Organizations Tufts Medical Center, Boston, MA, Tufts University School of Medicine, Boston, MA Abstract Disclosures Research Funding No funding received None. Background: CVD is the leading cause of non-cancer mortality for BC survivors. Clinical practice guidelines support the assessment and management of ASCVD risk factors among BC pts, including lipid-lowering therapy when indicated. We performed a single-institution, retrospective, longitudinal study of ASCVD risk factors and statin use for primary and secondary ASCVD prevention among BC pts. Methods: Pts diagnosed with BC from 2009-2015 were identified from the institutional cancer registry. Pts with non-metastatic BC or ductal carcinoma in situ and at least 2 years of follow up were included. Records were reviewed at 12-month intervals from BC diagnosis until last follow up or the study end date of 12/31/19. BC characteristics and treatment, prevalent and incident CV risk factors, CV diagnoses, CV medications, and CV events were manually abstracted and confirmed by a second reviewer. 10-year estimated ASCVD risk, based on non-laboratory predictors, was calculated for each pt. Chi-square tests were performed to assess the relationship between race/ethnicity, age category, and statin exposure. Results: 326 pts were included (median age at diagnosis 60.7 yrs; 67% White, 16% Asian (Chinese), 10% Black; 54% with stage I disease). At baseline, 53% had hypertension, 40% had hyperlipidemia, 37% were former or current smokers, 32% had a BMI ≥30, 7% had a history of ASCVD, and 5% had a family history of premature coronary artery disease. 52% received radiation therapy. 114 pts had radiation dosimetry available; 59 (18%) received a mean heart dose ≥1 Gy. Median follow up was 6.5 yrs. At the time of BC diagnosis, 64% of pts had an established indication for lipid-lowering therapy: history of ASCVD, diabetes, or estimated 10-year ASCVD risk ≥7.5% (Table). Of these pts with an indication for statin, 35% were prescribed a statin at baseline and 57% were prescribed a statin at any time during the study period. No association between baseline statin exposure and pt age category (X 2 = 3.75, p = 0.290) or race/ethnicity (X 2 = 2.64, p = 0.562) was observed. Among 11% of pts with ASCVD at any time, 83% were prescribed a statin but only 40% received a guideline-recommended high-intensity statin. Conclusions: A majority of pts in our study were candidates for statin therapy for primary or secondary ASCVD prevention at the time of BC diagnosis. 43% were never prescribed a statin, predominantly pts whose indication was primary prevention. There is opportunity for improvement in ASCVD prevention during BC treatment and follow up. Indication No. (% of cohort) Statin - baseline No. (% of subgroup) Statin - any time point No. (% of subgroup) Any Statin Indication (Baseline) 209 (64) 74 (35) 120 (57) Estimated ASCVD risk 7.5-19.9% 109 (33) 21 (28) 58 (53) Estimated ASCVD risk ≥20% 75 (23) 24 (32) 41 (55) Diabetes (Baseline) 49 (15) 28 (57) 34 (69) ASCVD (Baseline) 23 (7) 18 (78) 19 (83) ASCVD (Incident) 12 (4) 5 (41) 10 (83)