Alsheikh-Ali Alawi A, Trikalinos Thomas A, Kent David M, Karas Richard H
Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
J Am Coll Cardiol. 2008 Sep 30;52(14):1141-7. doi: 10.1016/j.jacc.2008.06.037.
We sought to assess whether statin-mediated reductions in low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of cancer.
We recently reported an inverse association between on-treatment LDL-C levels and incident cancer in statin-treated patients enrolled in large randomized controlled trials, raising concern that LDL-C lowering by statins may increase cancer risk. However, meta-analyses suggest a neutral overall effect of statins on incident cancer.
A systematic literature search identified 15 eligible randomized controlled trials of statins with >or=1,000 person-years of follow-up that provided on-treatment LDL-C levels and rates of incident cancers (19 statin and 14 control arms, 437,017 person-years cumulative follow-up, and 5,752 incident cancers).
In the statin arms, meta-regression analysis demonstrated an inverse association between on-treatment LDL-C and incident cancer, with an excess of 2.2 (95% confidence interval: 0.7 to 3.6) cancers per 1,000 person-years for every 10 mg/dl decrement in on-treatment LDL-C (p=0.006). The corresponding difference among control arms was 1.2 (95% confidence interval: -0.2 to 2.7, p=0.09). Compared with the control arms, the statin regression line was significantly shifted leftward, such that similar rates of incident cancer were associated with lower on-treatment LDL-C (p<0.05). Meta-regression demonstrated that statins lack an effect on cancer risk across all levels of on-treatment LDL-C.
There is an inverse association between on-treatment LDL-C and incident cancer. However, statins, despite producing marked reductions in LDL-C, are not associated with an increased risk of cancer.
我们试图评估他汀类药物介导的低密度脂蛋白胆固醇（LDL-C）降低是否与癌症风险增加相关。
我们最近报告了在大型随机对照试验中接受他汀类药物治疗的患者，治疗期间的LDL-C水平与新发癌症之间存在负相关，这引发了人们对他汀类药物降低LDL-C可能增加癌症风险的担忧。然而，荟萃分析表明他汀类药物对新发癌症的总体影响是中性的。
一项系统的文献检索确定了15项符合条件的他汀类药物随机对照试验，随访时间≥1000人年，这些试验提供了治疗期间的LDL-C水平和新发癌症发生率（19个他汀类药物组和14个对照组，累计随访437,017人年，5752例新发癌症）。
在他汀类药物组中，荟萃回归分析表明治疗期间的LDL-C与新发癌症之间存在负相关，治疗期间LDL-C每降低10mg/dl，每1000人年新增癌症2.2例（95%置信区间：0.7至3.6）（p=0.006）。对照组的相应差异为1.2例（95%置信区间：-0.2至2.7，p=0.09）。与对照组相比，他汀类药物的回归线明显向左移动，因此相似的新发癌症发生率与较低的治疗期间LDL-C相关（p<0.05）。荟萃回归表明，他汀类药物对所有治疗期间LDL-C水平的癌症风险均无影响。
治疗期间的LDL-C与新发癌症之间存在负相关。然而，他汀类药物尽管能显著降低LDL-C，但与癌症风险增加无关。
