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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER
Roger Bedimo1, Fatma Shebl2, Keith M. Sigel3, Sheldon T. Brown4, Kristina Crothers5, Matthew B. Goetz6, Amy C. Justice7, Janet Tate7
1VA North Texas Health Care Center, Dallas, TX, USA,2Yale University, New Haven, CT, USA,3Icahn School of Medicine at Mt Sinai, New York, NY, USA,4James J. Peters VA Medical Center, Bronx, NY, USA,5University of Washington, Seattle, WA, USA,6VA Greater Los Angeles Health Care System, Los Angeles, CA, USA,7VA Connecticut Healthcare System, West Haven, CT, USA
Beyond inhibition of cholesterol biosynthesis, statins appear to have pleiotropic effects, including modulation of cell growth, apoptosis, and inflammation. Statins may also reduce cancer risk, particularly among HIV-infected (HIV+) subjects who experience chronic inflammation and immune activation. Small observational studies have suggested an association between statin use and lower cancer risk in HIV+ but small sample sizes limited cancer type-specific analyses. Comparison of the association of statin exposure with cancer in HIV+ and HIV-uninfected comparators (HIV-) is also lacking. We used the Veterans Aging Cohort Study (VACS), a large observational cohort with cancer registry linkage and detailed pharmacy data to address these questions
We followed statin users identified between 2000-2012, beginning 180 days after an index date defined as first statin prescription for users and a random visit date in the same year for non-users. To account for known and potential confounders we fit a propensity score (PS) model for statin use including age, calendar year, smoking, chronic diseases (e.g., diabetes, hypertension, HCV co-infection, alcohol use disorder), and laboratory values (e.g., LDL, albumin). We matched each statin user to up to four non-users by PS. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) associated with statin use for all cancers, individual cancers, infection-related cancers (anal, colorectal, head and neck, liver, lymphoma, and stomach) and notinfection-related cancers.
The PS-matched sample included 48,214 participants, of whom 23,512 (48.8%) were incident statin users. Incident cancers were diagnosed in 940 (9.7%) of 9,649 HIV+ and 3,079 (8.0%) in 38,565 uninfected. Overall, statin use was associated with ~20% reduced risk of any cancer [HR 0.82 (95% CI 0.77 – 0.88)] and ~40% lower risk for infection-related cancers [HR 0.62 (95% CI 0.55 – 0.70)]. In general, the association was stronger in HIV+, but the interaction did not reach statistical significance except for non-Hodgkin lymphoma
Statin exposure is associated with lower risk of cancer independent of HIV status. This protective effect appears to be stronger for infection-related cancers.