Abstract 4144000: The association between statins and immune checkpoint inhibitor-associated cardiotoxicity

Background: Immune checkpoint inhibitors (ICIs) have been associated with major adverse cardiovascular events (MACE) that carry high morbidity and mortality. Statins are widely used for the primary prevention of MACE in patients with a high risk of atherosclerotic cardiovascular disease. However, the impact of statins on MACE associated with ICIs remained unclear. Research Question Is stain use associated with a reduction in MACE in patients treated with ICI? Aim To assess the effectiveness of statins on the primary prevention of MACE in patients treated with ICI. Methods: We conducted a retrospective, propensity score-matched cohort study using the TriNetX Analytics Network database. We included all adult cancer patients who were treated with an ICI between March 2011 and March 2023. We excluded patients with a history of MACE, defined as a composite of myocardial infarction, myocarditis, pericarditis, and cardiovascular death. Patients who received statins prior to ICI initiation were compared to those who did not receive statins prior to the start of ICI therapy. The primary efficacy outcome was MACE. Secondary efficacy outcomes were indivicual MACE. The safety outcomes included all-cause mortality and adverse events associated with statins. Cox proportional hazard ratios (HR) were calculated to compare study endpoints occurring within 1 year of ICI initiation between statins users and non-users. Results: Of 73,988 patients eligible for inclusion, 12,653 patients who received statins were matched to those who did not receive statins. The most common indication for an ICI was lung cancer (41%) and the most commonly administered ICI was pembrolizumab (50%). In a Cox proportional hazards analysis, patients on a statin were associated with a lower risk of MACE (HR, 0.83; 95% CI, 0.72-0.94) as compared to patients not on a statin. There was a reduction in the risk of myocardial infarction, cardiovascular death, and a lower trend of myocarditis among patients who received statins. Patients on a statin had a lower rate of all-cause mortality without an increase in adverse events. Conclusions: Statins were associated with a reduction in MACE and all-cause mortality among cancer patients receiving ICI therapy.