Statins and the risk of colorectal cancer
Statins and the risk of colorectal cancer
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DOI：
10.1056/nejmoa043792
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发表时间：
2005-05-26
影响因子：
158.5
通讯作者：
Rennert, G
中科院分区：
文献类型：
--
作者：
Poynter, JN;Gruber, SB;Rennert, G
背景他汀类药物是3-羟基-3-甲基戊二酰辅酶A还原酶的抑制剂，是有效的降脂药。他汀类药物可抑制结肠癌细胞系的生长，对一些（但不是全部）临床试验的二次分析表明，他汀类药物可以降低患结直肠癌的风险。方法结直肠癌分子流行病学研究是一项基于人群的病例对照研究，研究对象为 1998 年至 2004 年间在以色列北部被诊断为结直肠癌的患者以及根据年龄、性别、诊所和种族进行匹配的对照组。我们使用结构化访谈来确定两组中他汀类药物的使用情况，并通过检查可获得处方记录的亚组患者的处方记录来验证自我报告的他汀类药物使用情况。结果在包括 1953 名结直肠癌患者和 2015 年对照组的分析中，使用他汀类药物至少五年（相对于不使用他汀类药物）与结直肠癌相对风险显着降低相关（比值比为 0.50； 95% 置信区间，0.40 至 0.63）。在调整使用或不使用阿司匹林或其他非甾体抗炎药后，这种相关性仍然显着；是否有体力活动、高胆固醇血症以及结直肠癌家族史；民族;蔬菜消费水平（比值比，0.53；95% 置信区间，0.38 至 0.74）。使用纤维酸衍生物与显着降低结直肠癌风险无关（比值比，1.08；95% 置信区间，0.59 至 2.01）。在 286 名报告使用他汀类药物且记录可用的参与者中，有 276 人 (96.5%) 的自我报告的他汀类药物使用情况得到证实。 结论 在调整其他已知风险因素后，他汀类药物的使用与结直肠癌风险相对降低 47% 相关。由于绝对风险降低可能很低，因此有必要进一步研究他汀类药物在预防结直肠癌方面的总体益处。
BackgroundStatins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase and effective lipid-lowering agents. Statins inhibit the growth of colon-cancer cell lines, and secondary analyses of some, but not all, clinical trials suggest that they reduce the risk of colorectal cancer.MethodsThe Molecular Epidemiology of Colorectal Cancer study is a population-based case-control study of patients who received a diagnosis of colorectal cancer in northern Israel between 1998 and 2004 and controls matched according to age, sex, clinic, and ethnic group. We used a structured interview to determine the use of statins in the two groups and verified self-reported statin use by examining prescription records in a subgroup of patients for whom prescription records were available.ResultsIn analyses including 1953 patients with colorectal cancer and 2015 controls, the use of statins for at least five years (vs. the nonuse of statins) was associated with a significantly reduced relative risk of colorectal cancer (odds ratio, 0.50; 95 percent confidence interval, 0.40 to 0.63). This association remained significant after adjustment for the use or nonuse of aspirin or other nonsteroidal antiinflammatory drugs; the presence or absence of physical activity, hypercholesterolemia, and a family history of colorectal cancer; ethnic group; and level of vegetable consumption (odds ratio, 0.53; 95 percent confidence interval, 0.38 to 0.74). The use of fibric-acid derivatives was not associated with a significantly reduced risk of colorectal cancer (odds ratio, 1.08; 95 percent confidence interval, 0.59 to 2.01). Self-reported statin use was confirmed for 276 of the 286 participants (96.5 percent) who reported using statins and whose records were available.ConclusionsThe use of statins was associated with a 47 percent relative reduction in the risk of colorectal cancer after adjustment for other known risk factors. Because the absolute risk reduction is likely low, further investigation of the overall benefits of statins in preventing colorectal cancer is warranted.