Weill Cornell Medical College, New York, NY, United States.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States.
Gynecol Oncol. 2018 Mar;148(3):540-546. doi: 10.1016/j.ygyno.2018.01.006. Epub 2018 Feb 13.
Statins have anti proliferative activity in vitro against endometrial and ovarian cancer and can affect levels of reproductive hormones. We analyzed data from the Women's Health Initiative (WHI) to assess whether statins are associated with risk of endometrial and ovarian cancer.
The WHI study included 161,808 postmenopausal women in which incident cases of endometrial (n = 1377) and ovarian cancer (n = 763) were identified over an average of 10.8 (SD + 3.3) years. Information on statin use and risk factors was collected at baseline and follow-up. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of statin use and risk of endometrial and ovarian cancer. All statistical tests were two-sided.
Statins were used at baseline by 7.5% women and by up to 25% at year nine. The multivariable adjusted HR for risk of endometrial cancer for baseline statin use was 0.74, 95% C.I. 0.59-0.94 and for ovarian cancer was 1.15, 95% C.I. 0.89-1.50. In time-dependent models, statins were not associated with endometrial cancer (HR 0.91, 95% C.I. 0.76-1.08) however there was an increased risk of ovarian cancer (HR 1.30, 95% CI 1.04-1.62), largely attributed to the effect of the hydrophilic statin, pravastatin (1.89, 95% CI 1.24-2.88).
There was a reduction in risk of endometrial cancer among statin users at baseline but not in time-dependent models. Pravastatin use was associated with an increased risk of ovarian cancer. Analyses of larger numbers of cases are needed to evaluate these findings.
他汀类药物在体外对子宫内膜癌和卵巢癌具有抗增殖活性,并且可以影响生殖激素水平。我们分析了妇女健康倡议(WHI)的数据,以评估他汀类药物是否与子宫内膜癌和卵巢癌的风险相关。
WHI 研究包括 161808 名绝经后妇女,平均随访 10.8(+3.3)年后,共确诊了 1377 例子宫内膜癌和 763 例卵巢癌。在基线和随访时收集了他汀类药物使用情况和危险因素的信息。使用 Cox 比例风险回归计算了使用他汀类药物与子宫内膜癌和卵巢癌风险之间的风险比(HR)和 95%置信区间(CI)。所有统计检验均为双侧。
基线时,有 7.5%的女性使用他汀类药物,在第 9 年时,多达 25%的女性使用。多变量调整后的基线使用他汀类药物与子宫内膜癌风险的 HR 为 0.74,95%CI 为 0.59-0.94,与卵巢癌的 HR 为 1.15,95%CI 为 0.89-1.50。在时间依赖性模型中,他汀类药物与子宫内膜癌无关(HR 0.91,95%CI 0.76-1.08),但卵巢癌风险增加(HR 1.30,95%CI 1.04-1.62),这主要归因于亲水性他汀类药物普伐他汀的作用(HR 1.89,95%CI 1.24-2.88)。
在基线使用他汀类药物的患者中,子宫内膜癌的风险降低,但在时间依赖性模型中则没有。普伐他汀的使用与卵巢癌风险增加有关。需要对更多病例进行分析以评估这些发现。