Addison Daniel, Lawler Patrick R, Emami Hamed, Janjua Sumbal A, Staziaki Pedro V, Hallett Travis R, Hennessy Orla, Lee Hang, Szilveszter Bálint, Lu Michael, Mousavi Negar, Nayor Matthew G, Delling Francesca N, Romero Javier M, Wirth Lori J, Chan Annie W, Hoffmann Udo, Neilan Tomas G
Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Stroke. 2018 Jan;20(1):71-79. doi: 10.5853/jos.2017.01802. Epub 2018 Jan 31.
Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. Among broad populations, statins reduce CVEs; however, whether statins reduce CVEs after RT for HNCA is unclear. Therefore, we aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA.
From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors.
The final cohort consisted of 1,011 patients (59±13 years, 30% female, 44% hypertension) with 288 (28%) on statins. Over a median follow-up of 3.4 years (interquartile range, 0.1 to 14) there were 102 CVEs (89 ischemic strokes and 13 TIAs) with 17 in statin users versus 85 in nonstatins users. In a multivariable model containing known predictors of CVE, statins were associated with a reduction in the combination of stroke and TIA (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2 to 0.8; =0.01) and ischemic stroke alone (HR, 0.4; 95% CI, 0.2 to 0.8; =0.01).
Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.
头颈部癌（HNCA）放疗（RT）后需要采取干预措施以降低脑血管事件（CVE；中风和短暂性脑缺血发作[TIA]）的风险。在广泛人群中，他汀类药物可降低CVE；然而，他汀类药物是否能降低HNCA放疗后的CVE尚不清楚。因此，我们旨在测试放疗时偶然使用他汀类药物是否与HNCA放疗后较低的CVE发生率相关。
从机构数据库中，我们识别出2002年至2012年期间所有接受颈部放疗的连续HNCA患者。数据收集和事件判定由盲法团队进行。主要结局是缺血性中风和TIA的复合结局。次要结局是缺血性中风。在对传统和放疗特异性危险因素进行调整后，使用Cox比例风险模型确定他汀类药物使用与事件之间的关联。
最终队列包括1011例患者（59±13岁，30%为女性，44%患有高血压），其中288例（28%）使用他汀类药物。在中位随访3.4年（四分位间距，0.1至14年）期间，发生了102例CVE（89例缺血性中风和13例TIA），他汀类药物使用者中有17例，非他汀类药物使用者中有85例。在包含已知CVE预测因素的多变量模型中，他汀类药物与中风和TIA的联合发生率降低相关（风险比[HR]，0.4；95%置信区间[CI]，0.2至0.8；P = 0.01），单独与缺血性中风发生率降低相关（HR，0.4；95%CI，0.2至0.8；P = 0.01）。
HNCA放疗时偶然使用他汀类药物与较低的中风或TIA风险相关。
