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Statins associated with reduced cancer incidence in patients with heart failure

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New studies provide more evidence to support the idea that statins may play a role in cancer prevention.

This latest study-87,000 patients heart failure -Patients who took statins have been shown to have a significantly reduced risk of developing cancer and dying from cancer.

“In this large study of patients with heart failure, cancer incidence was reduced by 16% and cancer deaths were 36% in patients taking statins compared to patients not taking statins. We found it to decrease, “said senior author Kai-Hang Yiu, MD at the University of Hong Kong. Medscape Medical News..

“This is the largest study investigating the effects of statins in heart failure and the first major study investigating cancer-related outcomes in heart failure,” added Yiu. “Our results are important because the incidence of cancer in patients with heart failure is increasing.”

Research Published online In European Heart Journal June 23rd.

Yiu explained that patients with heart failure have better outcomes and live longer with better treatment. Reasons for death are shifting from cardiovascular events to non-cardiovascular conditions.

“In particular, cancer mortality is one of the most important non-cardiovascular mortality rates in heart failure patients, so it is important to look for strategies to reduce the cancer burden in these patients,” he said. It was.

He said other studies have suggested that statins have a chemoprotective effect, and his group wants to investigate this possibility more closely in the heart failure population.

In this study, Yiu et al. Analyzed data from 87,102 patients in Hong Kong who were hospitalized for heart failure between 2003 and 2015. Patients were followed until they were diagnosed with cancer, died, or by the end of 2018, whichever came first. ..

Participants were excluded from the study if they had a history of cancer, or if they were diagnosed with cancer or died of cancer within 90 days of the initial diagnosis of heart failure. HIV, Or if you have been taking statins for less than 90 days. This left 36,176 statin users and 50,926 non-statin users for analysis.

The results showed that during a median follow-up of 4.1 years, 11,052 patients (12.7%) were newly diagnosed with cancer and 3863 patients (4.4%) died of cancer. The most common types of cancer were the intestines, stomach, lungs, liver, and biliary system.

Consistent statin users had a lower risk of developing cancer than non-users. The 5-year cumulative incidence of cancer was 7.9% for statin users and 10.4% for non-users. The 10-year cumulative incidence of cancer was 11.2% for statin users and 13.2% for non-users.

Overall, statin users had a 16% lower risk of cancer than non-users after multivariate adjustment (hazard ratio). [HR], 0.84; 95% CI, 0.80 to 0.89).

The study also showed that statin users have a significantly lower risk of dying from cancer during the same period. The 10-year cancer-related mortality rate was 3.8% for statin users and 5.2% for non-users (HR, 0.74; 95% CI, 0.67 – 0.81).

The 10-year all-cause mortality rate was also lower for statin users compared to non-users: 60.5% vs 78.8% (HR, 0.62; 95% CI, 0.61 – 0.64).

The protective effect of statins seemed to increase with longer use. After taking statins for 3 months to 2 years and adjusting for other factors, patients take statins for 4 to 6 years, the risk is reduced by 18%, and statins for 6 years or more, the risk is reduced. Did. twenty two%.

Similarly, patients who took statins for 4 to 6 years had a 33% reduction in their risk of dying from cancer compared to those who took statins for 3 months to 2 years. The risk for patients who have taken statins for more than 6 years has been reduced by 39%.

“Our results are consistent with previous observational studies of patients taking statins, but our study is unique in that it specifically looked for this effect in patients with heart failure,” says Yiu. I commented.

“The 16% reduction isn’t a big number, but it’s a significant reduction and will make a clinical difference,” he added.

Yiu performed various sensitivity analyzes to further verify the results, gender, age, High blood pressure Condition, and diabetes. Results were consistent among these subgroups.

“Because this was an observational study, it is impossible to draw a clear conclusion that statins prevent cancer in patients with heart failure,” he said. “We certainly only know that from randomized studies, but this very large population study is very encouraging.”

As for the mechanisms that may be involved, researchers suggest that the well-known anti-inflammatory effects of statins may be a factor. In addition, statins have been shown to have antiproliferative effects, which may stop the progression of the cell cycle of cancer cells, they say.

Yiu points out that the chemopreventive effects seen in this study appeared to be independent of lipid regulation and low-density lipoprotein (LDL) levels. LDL Go down alone. “

He states that heart failure itself is not the current indication for treatment with statins, but many patients with heart failure have other conditions for which statins are indicated, such as ischemic heart disease. stroke, And diabetes.

“Our results show that we must think about non-cardiovascular and cardiovascular complications in patients with heart failure,” Yiu concludes. “Statins cannot be specifically recommended to prevent cancer in heart failure patients based on this observational data, but these results show that heart failure patients who are indicated for statins are using any of these agents. It should encourage clinicians to confirm that, and this data also provides support for randomized trials to obtain solid evidence of this effect. “

Robust observation data

comment Medscape Medical News, James Kirk, MD, MD, professor of medicine at the University of Washington Medical Center in Seattle, Washington, said: There is a lack of conclusive evidence that provides correlative evidence rather than cause and supports recommendations for the widespread use of statins solely for the prevention of cancer, even in the heart failure population. “

Kirkpatrick agrees with Yiu that such recommendations require randomized trials, but some current studies are examining available evidence of the benefits, burdens, and risks of statin therapy. It helps patients and clinicians in the field and states that it may upset the use of statins.

“Some patients with a family history (or perhaps an individual history) of heart failure and cancer and who are on the rise appropriately Coronary artery disease The risk may be more convincing to choose statin therapy, “he suggests.

Kirkpatrick points out that there were some “trade-offs” in cardiology. Cardiovascular death is prevented and more patients live long enough to develop cancer and dementia.

“Many people are happy to live longer, but in the elderly population facing the question of why they want to die, the calculus may be different. This study probably shows that statins are in this dilemma. It suggests that there is a possibility of partial improvement. ”He added.

The study was supported by the Sanming Medical Project in Shenzhen, China, and the University of Hong Kong-Shenzhen Hospital Fund for the major medical fields in Shenzhen. Researchers have not revealed the relevant financial relationship.

European Heart J.. Published online on June 23, 2021. Full text

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