Background
Radiotherapy (RT) has been shown to increase the risk of cardiovascular and cerebrovascular disease through mechanisms such as accelerated atherosclerosis. However, limited studies have focused on the effects of cardioprotective medications and their impacts on reducing CVD burden in patients treated with RT.
Methods
A literature search of PubMed, Embase and Scopus was performed in May 2024. Studies of adult patients treated with RT to the head and neck or mediastinum investigating the effect of cardioprotective medications (anti-hypertensives, lipid-lowering therapies or anti-thrombotic medications) on the incidence of cardiovascular events were eligible for inclusion. Studies that reported the prevalence of patients at high risk of cardiovascular disease using cardioprotective medications were also included.
Results
There were 9 studies which met eligibility for inclusion. Meta-analysis of three studies suggested that patients treated with RT to the head and neck region who received statin therapy had a reduced risk of cerebrovascular events, with a relative risk of 0.77 (95% CI 0.66-0.90). Only two studies investigated statin use in patients receiving radiotherapy to the mediastinum with both finding no difference in CVD events between the statin and non-statin groups. Four studies investigated the prevalence of cardioprotective medication use in patients treated with RT, with a significant proportion (38 – 88%) of patients with indications for lipid lowering therapy not currently prescribed these medications.
Conclusion
Statin therapy may be associated with a reduction in stroke for patients with head and neck cancer treated with RT. Clinicians involved in the care of patients treated with RT to the head and neck or mediastinum should be aware of the increased CVD risk and consider appropriate prescription of cardioprotective medications. Further research is required to prospectively evaluate the role of cardioprotective medications in the prevention of CVD in patients treated with RT.