Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).
National Centre for Healthy Ageing, Frankston, Australia (N.E.A).
Stroke. 2022 Oct;53(10):3202-3205. doi: 10.1161/STROKEAHA.122.038829. Epub 2022 Sep 6.
Evidence is growing on anticancer effects of statins. We investigated whether the effectiveness of treatment with statins after ischemic stroke on mortality is influenced by a history of cancer.
Analyses of 90-day survivors of ischemic stroke (2012-2016; 45 hospitals) using linked registry and administrative data. Dispense of statins within 90 days postdischarge was determined from pharmaceutical records. Participants were followed from 91 days postdischarge until death or June 30, 2018. History of cancer was determined from hospital data. Propensity score-adjusted Cox proportional hazards regression model was used to determine the association between being dispensed statins and survival. The influence of history of cancer on this association was assessed based on the concepts of (1) statistical interaction and (2) biological interaction using 3 indices: relative excess risk due to interaction>0, attributable proportion due to interaction >0, or synergy index >1.
Among 9948 eligible participants (median age=72 years, 42% female), there were 1463 deaths. In adjusted analyses, there was no statistical interaction between being dispensed statins and history of cancer on mortality (=0.156). However, being dispensed statins had a significant positive biological interaction with having a history of cancer on mortality: relative excess risk due to interaction, 2.80 (95% CI, 1.56-5.05), attributable proportion due to interaction, 0.45 (95% CI, 0.23-0.66), and synergy index, 2.14 (95% CI, 1.32-3.49).
Treatment with statins after ischemic stroke may confer additional survival benefits for people who also have had cancer.
他汀类药物具有抗癌作用的证据不断增加。我们研究了缺血性卒中后使用他汀类药物治疗的有效性是否受到癌症病史的影响。
利用链接的登记处和行政数据对 2012-2016 年 90 天内缺血性卒中幸存者（45 家医院）进行分析。从药物记录中确定出院后 90 天内的他汀类药物处方。参与者从出院后第 91 天开始随访，直至死亡或 2018 年 6 月 30 日。癌症病史从医院数据中确定。使用倾向评分调整的 Cox 比例风险回归模型来确定出院后开具他汀类药物与生存之间的关联。基于（1）统计学交互和（2）生物学交互的概念，使用 3 个指标评估癌症病史对这种关联的影响：交互归因超额风险>0、交互归因比例>0 或协同指数>1。
在 9948 名合格参与者中（中位数年龄为 72 岁，42%为女性），有 1463 人死亡。在调整后的分析中，他汀类药物的使用与癌症病史之间在死亡率上没有统计学交互（=0.156）。然而，他汀类药物的使用与癌症病史之间存在显著的生物学正交互作用：交互归因超额风险为 2.80（95%CI，1.56-5.05），交互归因比例为 0.45（95%CI，0.23-0.66），协同指数为 2.14（95%CI，1.32-3.49）。
缺血性卒中后使用他汀类药物治疗可能为患有癌症的患者带来额外的生存获益。
