Statins and cancer risk
Statins and cancer risk
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DOI：
10.1016/j.amjmed.2007.12.011
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发表时间：
2008-04-01
影响因子：
5.9
通讯作者：
Pilote, Louise
中科院分区：
文献类型：
--
作者：
Karp, Igor;Behlouli, Hassan;Pilote, Louise
目的：尽管有大量的随机临床试验和观察流行病学研究，但关于他汀类药物预防癌症的潜在有效性的证据仍然存在争议。本研究的目的是调查脂溶性他汀类药物的使用与癌症发生的关系。方法：我们基于加拿大魁北克省的一个医疗管理数据库(1998-2004)进行了一项回顾性观察研究。纳入年龄在45岁或以上且因急性心肌梗塞入院后活着出院的患者。高剂量和低剂量他汀类药物的使用被定义为在指数出院后3天内，达到或高于(低于)他汀类药物的特定目标剂量，用于4种脂溶性他汀类药物中的任何一种：阿托伐他汀、辛伐他汀、洛伐他汀或氟伐他汀。未使用他汀类药物被定义为在同时使用主要的非他汀类心脏药物的同时不使用任何他汀类药物。共有30076名患者接受了长达7年的随访，其中包括大剂量他汀类药物使用者(6015名)、低剂量他汀类药物使用者(5323名)和未使用他汀类药物的患者(18738名)。结果：他汀类药物高剂量使用组、低剂量使用组和不使用他汀类药物组的住院粗发病率分别为13.9、17.2和26.0/1000人年。大剂量使用他汀类药物的估计调整风险比为0.75(95%可信区间，0.60-0.95)，小剂量使用他汀类药物的调整后风险比为0.89(95%可信区间，0.75-1.07)。两种剂量的他汀类药物的作用均未发现明显的时间依赖性。结论：使用足够高剂量的脂溶性他汀类药物可能与临床上重要的癌症发病率的降低有关。(C)2008 Elsevier Inc.保留所有权利。
OBJECTIVE: Despite numerous randomized clinical trials and observational epidemiologic studies, evidence on the potential effectiveness of statins for prevention of cancer remains controversial. The objective of this study was to investigate the relation between lipophilic statin use and cancer occurrence.METHODS: We conducted a retrospective observational study based on a medical administrative database in the province of Quebec, Canada (1998-2004). Patients aged 45 years or more and discharged from the hospital alive after admission for acute myocardial infarction were included. High-and low-dose statin use were defined as a filled prescription, within 3 days after index discharge, at or above (below) the statin-specific target dose, for any of the 4 lipophilic statin medications: atorvastatin, simvastatin, lovastatin, or fluvastatin. Statin non-use was defined as non-use of any statins while simultaneously using major non-statin cardiac medications. A total of 30,076 patients, including high-dose statin users (n = 6015), low-dose statin users (n = 5323), and non-users (n = 18,738), were followed for up to 7 years. Multivariable Cox regression analyses were performed to estimate associations between statin dose category and the incidence of admission to hospital with a diagnosis of any type of cancer.RESULTS: The crude incidence rates of hospital admission with the diagnosis of any type of cancer were 13.9, 17.2, and 26.0 per 1000 person-years in statin high-dose users, low-dose users, and non-users, respectively. The estimated adjusted hazard ratios were 0.75 (95% confidence interval [CI], 0.60-0.95) for statin use at high dose and 0.89 (95% CI, 0.75-1.07) for statin use at low dose. No significant time-dependence of the effect of statins at either dose was detected.CONCLUSION: The use of lipophilic statins at sufficiently high dose might be associated with a clinically important reduction in the incidence of cancer. (C) 2008 Elsevier Inc. All rights reserved.