Statin use and all-cancer survival: prospective results from the Women's Health Initiative.
Statin use and all-cancer survival: prospective results from the Women's Health Initiative.
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DOI：
10.1038/bjc.2016.149
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发表时间：
2016-06-28
影响因子：
8.8
通讯作者：
Stefanick ML
中科院分区：
文献类型：
--
作者：
Wang A;Aragaki AK;Tang JY;Kurian AW;Manson JE;Chlebowski RT;Simon M;Desai P;Wassertheil-Smoller S;Liu S;Kritchevsky S;Wakelee HA;Stefanick ML
本研究的目的是调查他汀类药物的使用与绝经后妇女的前瞻性队列中所有癌症生存率之间的关联，使用来自妇女健康倡议观察性研究（WHI-OS）和临床试验（WHI-CT）的数据。WHI研究从1993年至1998年在40个美国临床中心招募了50-79岁的女性。在146326名参与者中，平均随访时间为14.6年，观察到23067例癌症事件和3152例癌症死亡。采用多变量校正的考克斯比例风险模型研究他汀类药物使用与癌症生存率之间的关系。与从未使用过他汀类药物的患者相比，目前使用他汀类药物的患者癌症死亡风险（风险比（HR），0.78; 95%置信区间（CI），0.71-0.86，P<0.001）和全因死亡率（HR，0.80; 95% CI，0.74-0.88）显著降低。使用其他降脂药物也与癌症生存率增加相关（P-交互作用（int）=0.57）。癌症死亡的较低风险不依赖于他汀类药物效力（P-int=0.22）、亲脂性/亲水性（P-int=0.43）、类型（P-int=0.34）或持续时间（P-int=0.33）。然而，与从未使用过他汀类药物者相比，既往使用过他汀类药物者的癌症死亡风险并不低（HR，1.06; 95%CI，0.85-1.33）;此外，尽管他汀类药物对生存率有影响，但其使用与总体癌症发病率的降低无关（HR，0.96; 95%CI，0.92-1.001）。在一组绝经后妇女中，定期使用他汀类药物或其他降脂药物与癌症死亡率降低相关，无论使用他汀类药物的类型、持续时间或效力如何。
This study aims to investigate the association between statin use and all-cancer survival in a prospective cohort of postmenopausal women, using data from the Women's Health Initiative Observational Study (WHI-OS) and Clinical Trial (WHI-CT). The WHI study enrolled women aged 50–79 years from 1993 to 1998 at 40 US clinical centres. Among 146 326 participants with median 14.6 follow-up years, 23 067 incident cancers and 3152 cancer deaths were observed. Multivariable-adjusted Cox proportional hazards models were used to investigate the relationship between statin use and cancer survival. Compared with never-users, current statin use was associated with significantly lower risk of cancer death (hazard ratio (HR), 0.78; 95% confidence interval (CI), 0.71–0.86, P<0.001) and all-cause mortality (HR, 0.80; 95% CI, 0.74–0.88). Use of other lipid-lowering medications was also associated with increased cancer survival (P-interaction (int)=0.57). The lower risk of cancer death was not dependent on statin potency (P-int=0.22), lipophilicity/hydrophilicity (P-int=0.43), type (P-int=0.34) or duration (P-int=0.33). However, past statin users were not at lower risk of cancer death compared with never-users (HR, 1.06; 95% CI, 0.85–1.33); in addition, statin use was not associated with a reduction of overall cancer incidence despite its effect on survival (HR, 0.96; 95% CI, 0.92–1.001). In a cohort of postmenopausal women, regular use of statins or other lipid-lowering medications was associated with decreased cancer death, regardless of the type, duration, or potency of statin medications used.