Statins Linked to Lower Cancer Mortality (CME/CE)

FG_AUTHORS: MedPage Today

By Michael Smith, North American Correspondent, MedPage Today
Published: November 07, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

Statin use is associated with a lower risk of dying from cancer for people who used the cholesterol-lowering drugs before their cancer diagnosis, researchers reported.

In a nationwide analysis of cancer patients in Denmark, statin users had a 15% reduction in the risk of cancer mortality compared with those who had not used the drugs, according to Stig Bojesen, MD, PhD, of the Copenhagen University Hospital in Denmark, and colleagues.

They had a similar reduction in the risk of all-cause mortality, Bojesen and colleagues reported in the Nov. 8 issue of the New England Journal of Medicine.

The findings suggest "a need for trials of statins in patients with cancer," the researchers concluded.

Despite the fact that trials of the drugs to reduce cardiovascular disease have not shown any reduction either in cancer incidence or mortality, Bojesen and colleagues noted, there is evidence that the biochemical pathways involved in cancer growth and spread can be affected by statins.

That suggested that cancer patients who were statin users before their cancer diagnosis might do better than those who were not, the researchers theorized.

To examine the issue, they turned to Danish national databases for information on all Danes who were diagnosed with cancer between Jan. 1, 1995 and Dec. 31, 2007, with follow-up until Dec. 31, 2009.

The databases allowed study of statin prescriptions, cancer diagnoses, and mortality.

All told, among cancer patients 40 and older, 18,721 had used statins regularly before the diagnosis and 277,204 had never been given the drugs, they reported.

During 1,072,503 person-years of follow-up, 162,067 patients died of cancer, 14,489 of cardiovascular causes, and 19,038 of other causes, the researchers reported.

Analysis showed that:

  • The cumulative incidence of death from cancer, as a function of follow-up time, was significantly lower among statin users than among patients who had never used statins, with a log-rank P<0.001.
  • The multivariable hazard ratio was 0.85, with a 95% confidence interval from 0.82 to 0.87.
  • The cumulative incidence of death from any cause was also lower, with a log-rank P<0.001.
  • The multivariable hazard ratio was 0.85, with 95% confidence interval from 0.83 to 0.87.

Outcomes were similar regardless of the dose of statin given.

Bojesen and colleagues cautioned, among other things, that the study was based on the mostly white population of Denmark, but may not apply more widely.

They also noted that it is possible that statin use was a marker of increased health awareness, which might bias the results, and some data on characteristics of the cancers were not available.

The limitations of the study mean it is too soon to start a clinical trial to test statins in cancer, argued Neil Caporaso, MD, of the National Cancer Institute in Bethesda, Md.

In an accompanying editorial, Caporaso said the first step should be to examine existing research to figure out the "agent, dose, and duration of follow-up for an efficient, powerful, and convincing study of this important public health question."

Population studies are also needed to extend the results beyond Denmark, he argued, as well as basic science research to tease out mechanisms.

But, Caporaso wrote, the best approach would be to incorporate many research goals into interdisciplinary studies. "The effective solutions we seek will neither reside nor be effectively applied within a single discipline," he concluded.

The researchers did not report any external support for the study. Bojesen did not disclose any relevant financial relationships.

Caporaso did not report any relevant financial disclosures.

Primary source: New England Journal of Medicine
Source reference:
Nielsen SF, et al "Statin use and reduced cancer-related mortality" N Engl J Med 2012; 367: 1792-1802.

Additional source: New England Journal of Medicine
Source reference:
Caporaso NE "Statins and cancer-related mortality -- let's work together" N Engl J Med 2012; 367: 1848-1850.

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