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Statin use and all-cancer mortality: Prospective results from the Women’s Health Initiative. Ange Wang, Aaron K Aragaki, Jean Y. Tang, Allison W. Kurian, JoAnn E Manson, Rowan T. Chlebowski, Michael S. Simon, Pinkal M. Desai, Sylvia Wassertheil-Smoller, Simin Liu, Stephen Kritchevsky, Heather A. Wakelee, Marcia L. Stefanick; Stanford Univ School of Medcn, South Pasadena, CA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Stanford University School of Medicine, Redwood City, CA; Stanford University Medical Center, Stanford, CA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Karmanos Cancer Inst, Detroit, MI; Weill Cornell Medcll Coll, Starr 3, NY; Albert Einstein College of Medicine, Bronx, NY; Brown University, Providence, RI; Wake Forest University, School of Medicine, Winston-Salem, NC; Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA; Stanford Prevention Research Center, Stanford, CA
Background: Statin medications are widely used for lipid lowering and heart disease prevention. Retrospective studies and basic scientific evidence have suggested that statins may also reduce cancer mortality. Data fromthe Women’s Health Initiative Observational Study (WHI-OS) and Clinical Trial (WHI-CT) were used to investigate the association between statin use and all-cancer mortality in a prospective cohort of postmenopausal women. Methods: The WHI study enrolled women aged 50-79 from 1993-1998 at 40 U.S. clinical centers. Among 146,326 participants with median 14.6 follow-up years, 23,067 incident cancers and 3,152 cancer deaths were observed. Cox proportional hazards models were used to investigate the relationship between statin use (as a time-dependent exposure) and cancer mortality. Analyses were adjusted for age, race/ethnicity, education, smoking, body mass index, physical activity, family history of cancer, current health care provider, hormone use, age at menarche, solar irradiance, and history of heart disease/diabetes. Results: Compared with never users, current statin use was associated with significantly decreased cancer mortality (HR 0.78; 95% CI 0.71-0.86). Use of other lipid lowering medications was associated with a similar reduction in cancer deaths compared to monotherapy statin use (p-het = 0.57). The reduction in cancer death associated with statin use was not dependent on statin potency (p-het = 0.22), lipophilicity/hydrophilicity (p-het = 0.43), type (p-het = 0.34) or duration (p-het = 0.33). Current statin use was associated with significantly decreased mortality of multiple cancer types, including breast, colorectal, ovarian, digestive, and bone/connective tissue cancer deaths, but not lung cancer. However, past statin users were not at lower risk of cancer death compared to never users (HR 1.06; 95% CI, 0.85-1.33); additionally, statin use was not associated with a reduction in cancer incidence despite its effect on mortality (HR, 0.96; 95% CI: 0.92-1.001). Conclusions: In a cohort of postmenopausal women, regular use of statins or other lipid-lowering medications may decrease cancer mortality, regardless of the type, duration, or potency of statin medications used. Clinical trial information: NCT00000611 |
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