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Statin Use and Reduced Cancer-Related Mortality
Study Questions:
What is the association between statin use begun before a cancer diagnosis and reduced cancer-related mortality among the Danish population?
Methods:
This was a nationwide study of the entire Danish population who had received a diagnosis of cancer between 1995 and 2007. Statin type and dose were recorded from a national registry; patients who had statin prescriptions filled within 6 months before the date of the cancer diagnosis and within 2 years before the date of diagnosis were classified as regular statin users. The outcome of interest was cause and date of death.
Results:
The multivariable-adjusted hazard ratio for death from any cause among statin users, as compared with patients who had never used statins, was 0.85 (95% confidence interval [CI], 0.83-0.87). While the cumulative incidence of death from any cause as a function of follow-up time from the date of cancer diagnosis was lower among statin users than among patients who had never used statins (p < 0.001 by the log-rank test), the two curves converged after 5 years of follow-up. There was heterogeneity in the magnitude of reduced cancer-related mortality among statin users for different cancer types, most pronounced for cervical cancer with a multivariable-adjusted hazard ratio of 0.64 (95% CI, 0.46-0.88) for death from cancer among statin users. Notably, there was no discernible pattern of decreased mortality with increasing dose.
Conclusions:
Among patients who develop cancer, antecedent statin use is associated with reduced cancer-related mortality.
Perspective:
While it is tempting to accept that statin use in Denmark has caused a substantial decline in all-cause and cancer-related mortality, the limitations of this study should be acknowledged. Though mitigated by propensity-score analysis, the presence of bias by indication and healthy user bias cannot be discounted. The results of this study are hypothesis-generating, and should create momentum toward population studies that may verify these findings and more completely eliminate biases and capture information (e.g., smoking status) not available in the present study. Without such verification, it may be premature to make meaningful changes or execute statin trials in patients with cancer.
Keywords: Uterine Cervical Neoplasms, Incidence, Salicylates, Neoplasms, Follow-Up Studies, Cardiology, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Denmark, Cardiovascular Diseases
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