前瞻性分析妇女健康倡议研究中他汀类药物使用与乳腺癌风险的相关性。
Prospective analysis of association between statin use and breast cancer risk in the women's health initiative.
机构信息
Authors' Affiliations: Weill Cornell Medical College, New York, New York; Wayne State University; Barbara Ann Karmanos Cancer Institute, Detroit, Michigan; Los Angeles Biomedical Research Institute at Harbor, University of California, Los Angeles Medical Center, Los Angeles; University of California, Irvine, Irvine, California; Stony Brook University Medical Center, Stony Brook, New York; Harvard School of Public Health, Boston, Massachusetts; Fred Hutchinson Cancer Research Center, Seattle, Washington; George Washington University, Washington, District of Columbia; NorthShore University Health System, Evanston, Illinois; Albert Einstein College of Medicine, New York; University at Buffalo, The State University of New York, Buffalo, New York; Henry Ford Health Systems, Detroit, Michigan; Lakeland Regional Medical Center, St. Joseph, Michigan; West Virginia University, Morgantown, West Virginia; and University of Tennessee Health Science Center, Memphis, Tennessee.
出版信息
Cancer Epidemiol Biomarkers Prev. 2013 Oct;22(10):1868-76. doi: 10.1158/1055-9965.EPI-13-0562. Epub 2013 Aug 23.
BACKGROUND
Statins are a class of cholesterol-lowering drugs that affect many intracellular pathways that may have implications for chemoprevention against cancer. Epidemiologic data on statins and breast cancer are conflicting. We analyzed updated data from the Women's Health Initiative (WHI) to assess the relationship between statins and breast cancer risk.
METHODS
The population included 154,587 postmenopausal women ages 50 to 79 years, with 7,430 pathologically confirmed cases of breast cancer identified over an average of 10.8 (SD, 3.3) years. Information on statins was collected at baseline and years one, three, six, and nine. Self- and interviewer-administered questionnaires were used to collect information on risk factors. Cox proportional hazards regression was used to calculate HRs with 95% confidence intervals (CI) to evaluate the relationship between statin use and cancer risk. Statistical tests were two-sided.
RESULTS
Statins were used by 11,584 (7.5%) women at baseline. The annualized rate of breast cancer was 0.42% among statin users and 0.42% among nonusers. The multivariable adjusted HR of breast cancer for users versus nonusers was 0.94 (95% CI, 0.83-1.06). In the multivariable-adjusted, time-dependent model, the HR for simvastatin was 0.87 (95% CI, 0.71-1.07). There was no significant trend by overall duration of use (P value for trend 0.68). There was no effect of tumor stage, grade, or hormone receptor status.
CONCLUSION
Overall, statins were not associated with breast cancer risk.
IMPACT
Our study is one of the largest prospective observational studies on this topic, and substantially adds to the literature suggesting no relationship between statins and breast cancer risk.
背景
他汀类药物是一类降低胆固醇的药物，可影响许多细胞内途径，这些途径可能对癌症的化学预防有影响。关于他汀类药物和乳腺癌的流行病学数据存在矛盾。我们分析了妇女健康倡议（WHI）的最新数据，以评估他汀类药物与乳腺癌风险之间的关系。
方法
该人群包括 154587 名年龄在 50 至 79 岁之间的绝经后妇女，在平均 10.8（SD，3.3）年的时间内发现了 7430 例经病理证实的乳腺癌病例。在基线时以及第 1、3、6 和 9 年收集了关于他汀类药物的信息。自我和访谈者管理的问卷用于收集危险因素信息。使用 Cox 比例风险回归计算 HRs 和 95%置信区间（CI），以评估他汀类药物使用与癌症风险之间的关系。统计检验为双侧。
结果
在基线时，有 11584 名（7.5%）妇女使用了他汀类药物。在他汀类药物使用者和非使用者中，乳腺癌的年化发生率分别为 0.42%和 0.42%。使用者与非使用者相比，乳腺癌的多变量调整 HR 为 0.94（95% CI，0.83-1.06）。在多变量调整、时间依赖模型中，辛伐他汀的 HR 为 0.87（95% CI，0.71-1.07）。使用时间长短与 HR 之间无显著趋势（趋势检验 P 值为 0.68）。肿瘤分期、分级或激素受体状态均无影响。
结论
总体而言，他汀类药物与乳腺癌风险无关。
影响
我们的研究是该主题最大的前瞻性观察研究之一，大大增加了表明他汀类药物与乳腺癌风险之间没有关系的文献。
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