Main Session
Sep
28
PQA 02 - Lung Cancer/Thoracic Malignancies, Patient Reported Outcomes/QoL/Survivorship, Pediatric Cancer
2452 - Cardioprotective Medications and the Incidence of Cardiovascular Events in Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis
Presenter(s)
Vishwa Pakeerathan, MBBS - Princess Alexandra Hospital, Woolloongabba, QLD
V. Pakeerathan1,2, R. Marwah3,4, A. R. Mohammed3,4, and J. Smith5,6; 1Princess Alexandra Hospital, Brisbane, QLD, Australia, 2University of Queensland, Faculty of Medicine, Griffith University, School of Medicine and Dentistry, Brisbane, QLD, Australia, 3Townsville University Hospital, Townsville, QLD, Australia, 4James Cook University, College of Medicine and Dentistry, Townsville, QLD, Australia, 5Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia, 6Faculty of Medicine, University of Queensland, Brisbane, Australia
Purpose/Objective(s):
Radiotherapy (RT) has been shown to increase the risk of cardiovascular disease (CVD) through mechanisms such as accelerated atherosclerosis. However, limited studies have focused on the prescription of cardioprotective medications in patients treated with RT and their impact on reducing CVD. The purpose of this systematic review and meta-analysis is to explore the utilization of cardioprotective medications in patients treated with RT and their impact on cardiovascular and cerebrovascular events.Materials/Methods:
A literature search of PubMed, Embase and Scopus was performed in January 2025. Studies of adult patients treated with RT to the head and neck or mediastinum investigating the effect of cardioprotective medications (defined as anti-hypertensives, lipid-lowering therapies or anti-thrombotic medications) on the incidence of cardiovascular or cerebrovascular events were eligible for inclusion. Studies that reported the proportion of patients treated with RT who were utilizing cardioprotective medications as recommended by CVD guidelines were also included. Meta-analysis was performed using R (Version 4.3.1) with a random effects model for outcomes with three or more studies.Results:
There were 10 retrospective studies which were eligible for inclusion. Five of the ten studies included patients with head and neck cancer only, whilst two studies investigated outcomes for patients with lung cancer and one study included patients with breast cancer alone. Meta-analysis of three studies suggested that patients treated with RT who received statin therapy had a reduced risk of cerebrovascular events (stroke or transient ischemic attack), with a relative risk of 0.77 (95% CI 0.66-0.90). There was no difference in major adverse cardiac events (MACE) for patients treated with RT to the mediastinum who received statin therapy compared to those who did not (relative risk 1.02, 95% CI 0.71 to 1.46, n = 5 studies). A meta-analysis of four studies suggested that 59% (95% CI 35% to 80%) of patients treated with RT not on statin therapy had indications for commencement of these cardioprotective medications.Conclusion:
Current evidence exploring the impact of cardioprotective medications on CVD risk in patients treated with RT is heterogenous and limited to retrospective non-randomized studies. Statin therapy may be associated with a reduction in stroke for patients treated with RT, although this requires further investigation in prospective studies. It is evident that a considerable proportion of patients undergoing RT are not being prescribed cardioprotective medications as suggested by existing CVD guidelines. Clinicians involved in the care of patients treated with RT should therefore be aware of the increased CVD risk amongst this cohort and advocate for the prescription of cardioprotective medications when indicated.