Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Eur J Epidemiol. 2019 Nov;34(11):997-1011. doi: 10.1007/s10654-019-00565-8. Epub 2019 Sep 26.
Background Statins have previously been shown to have protective effects for other cancers, but no prospective studies of statin use and glioma have been conducted. Methods We evaluated the association between statin use and risk of glioma in the female Nurses' Health Study (NHS, n = 114,419) and Nurses' Health Study II (NHSII, n = 115,813) and the male Health Professionals Follow-up Study (HPFS, n = 50,223). Glioma cases were confirmed by medical record review. Age and multivariable-adjusted hazard ratios of glioma by statin use were estimated using Cox proportional hazards models. Results In 4,430,700 person-years of follow-up, we confirmed 483 incident cases of glioma. Compared with never-users, ever statin use was associated with borderline increased risk of glioma in the combined cohorts (age-adjusted HR = 1.23, 95% CI 0.99-1.54), as was longer duration of statin use (HR = 1.48, 95% CI 1.08-2.03 comparing > 8 years of use to never use, p-trend = 0.01). We also observed a significant inverse association between hyperlipidemia and glioma in multivariable models (HR = 0.74, 95% CI 0.59-0.93 in combined cohorts), which was attenuated in lagged analyses. Compared to never use, in multivariable-adjusted models, ever statin use (HR = 1.43, 95% CI 1.10-1.86) and statin use duration (HR = 1.72, 95% CI 1.21-2.45, for > 8 years of use, p-trend = 0.003) were each significantly associated with increased glioma risk. Conclusion In contrast to case-control studies reporting inverse associations, we found borderline increased risk of glioma with statin use. Results were strengthened after adjustment for cardiovascular risk factors due to an unexpected inverse association between hyperlipidemia and glioma risk. Further studies of statin use, hyperlipidemia, and glioma risk are warranted.
他汀类药物先前已被证明对其他癌症具有保护作用，但尚未进行关于他汀类药物使用与胶质瘤之间关系的前瞻性研究。
我们评估了他汀类药物使用与女性护士健康研究（NHS，n=114419）和护士健康研究 II（NHSII，n=115813）以及男性健康专业人员随访研究（HPFS，n=50223）中胶质瘤风险之间的关联。通过病历审查确认胶质瘤病例。使用 Cox 比例风险模型估计使用他汀类药物的年龄和多变量调整后的胶质瘤风险比。
在 4430700 人年的随访期间，我们确认了 483 例胶质瘤病例。与从未使用者相比，合并队列中他汀类药物的使用与胶质瘤风险的边界增加相关（年龄调整后的 HR=1.23，95%CI 0.99-1.54），他汀类药物使用时间较长也与胶质瘤风险增加相关（与从不使用相比，使用时间>8 年的 HR=1.48，95%CI 1.08-2.03，p 趋势=0.01）。在多变量模型中，我们还观察到高血脂症与胶质瘤之间存在显著的负相关关系（合并队列中的 HR=0.74，95%CI 0.59-0.93），但在滞后分析中这种关系减弱了。与从不使用相比，在多变量调整模型中，他汀类药物的使用（HR=1.43，95%CI 1.10-1.86）和他汀类药物使用时间（HR=1.72，95%CI 1.21-2.45，>8 年使用，p 趋势=0.003）与胶质瘤风险增加显著相关。
与报告相反关系的病例对照研究相比，我们发现使用他汀类药物与胶质瘤风险的边界增加有关。由于高血脂症与胶质瘤风险之间存在意外的负相关关系，因此在调整心血管危险因素后，结果得到了加强。需要进一步研究他汀类药物使用、高血脂症和胶质瘤风险之间的关系。
