Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
JAMA Netw Open. 2023 Apr 3;6(4):e239515. doi: 10.1001/jamanetworkopen.2023.9515.
In addition to protective effects on the cardiovascular system, statins may reduce the risk of breast cancer recurrence owing to potential anti-inflammatory benefits. Given that patients with breast cancer in Asia are relatively younger at diagnosis and most are free from traditional cardiovascular risk factors, it is uncertain whether the use of statins can improve survival.
To investigate the association of statin use with cancer- and noncancer-associated survival in patients with breast cancer.
DESIGN, SETTING AND PARTICIPANTS: This cohort study used the Taiwanese National Health Insurance Research Database and National Cancer Registry to identify patients diagnosed with breast cancer from January 2012 to December 2017. Age, cancer stage, anticancer therapies, comorbidities, socioeconomic status, and cardiovascular drugs were matched by propensity score method. Statistical analyses, including Cox proportional hazards models, were performed from June 2022 to February 2023. The mean (SD) follow-up duration was 4.10 (2.96) years.
Patients receiving statins within 6 months before the diagnosis of breast cancer were compared with those not receiving statins.
Outcomes included death, heart failure, and arterial and venous events.
Overall, 7451 patients (mean [SD] age, 64.3 [9.4] years) treated with statins were matched with 7451 nonusers (mean [SD] age, 65.8 [10.8] years). Compared with nonusers, statin users had a significantly lower risk of all-cause death (adjusted hazard ratio [HR], 0.83; 95% CI, 0.77-0.91; P < .001). Notably, the risk reduction was mainly attributed to cancer-related death (adjusted HR, 0.83; 95% CI, 0.75-0.92; P < .001). Only a small number of patients died of cardiovascular causes, and the ratios were similar between statin users and nonusers. No significant differences were observed in cardiovascular outcomes, including heart failure and arterial and venous events, between statin users and nonusers. Using a time-dependent analysis, statin users also presented a significantly lower risk of cancer-related death (adjusted HR, 0.28; 95% CI, 0.24-0.32; P < .001) than nonusers, and notably, the risk was even lower in high-dose statin (HDS) users compared with non-HDS users (HDS users: adjusted HR, 0.84; 95% CI, 0.73-0.98; P = .002; non-HDS users: adjusted HR, 0.79; 95% CI, 0.68-0.91; P = 001).
In this cohort study of Asian patients with breast cancer, statin use was associated with a reduced risk of cancer-associated death rather than cardiovascular death. Our findings provide evidence to support the use of statins in patients with breast cancer; however, randomized studies are necessary.
除了对心血管系统的保护作用外，他汀类药物可能通过潜在的抗炎作用降低乳腺癌复发的风险。鉴于亚洲乳腺癌患者的诊断年龄相对较轻，且大多数患者没有传统的心血管危险因素，因此尚不确定他汀类药物的使用是否能提高生存率。
研究他汀类药物的使用与乳腺癌患者的癌症相关和非癌症相关生存的关系。
设计、设置和参与者：本队列研究使用了台湾全民健康保险研究数据库和国家癌症登记处，从 2012 年 1 月至 2017 年 12 月确定了乳腺癌患者。通过倾向评分匹配法匹配年龄、癌症分期、抗癌治疗、合并症、社会经济地位和心血管药物。从 2022 年 6 月至 2023 年 2 月进行了包括 Cox 比例风险模型在内的统计分析。平均（SD）随访时间为 4.10（2.96）年。
比较了在乳腺癌诊断前 6 个月内使用他汀类药物的患者与未使用他汀类药物的患者。
结局包括死亡、心力衰竭和动脉及静脉事件。
共有 7451 例（平均[SD]年龄，64.3[9.4]岁）接受他汀类药物治疗的患者与 7451 例未使用者（平均[SD]年龄，65.8[10.8]岁）相匹配。与未使用者相比，他汀类药物使用者的全因死亡风险显著降低（调整后的危险比[HR]，0.83；95%置信区间，0.77-0.91；P < 0.001）。值得注意的是，这种风险降低主要归因于癌症相关死亡（调整后的 HR，0.83；95%置信区间，0.75-0.92；P < 0.001）。仅有少数患者死于心血管原因，且他汀类药物使用者和未使用者之间的比例相似。他汀类药物使用者和未使用者的心血管结局（包括心力衰竭和动脉及静脉事件）无显著差异。使用时间依赖性分析，他汀类药物使用者的癌症相关死亡风险也显著低于未使用者（调整后的 HR，0.28；95%置信区间，0.24-0.32；P < 0.001），而且在高剂量他汀类药物（HDS）使用者中风险甚至更低，与非 HDS 使用者相比（HDS 使用者：调整后的 HR，0.84；95%置信区间，0.73-0.98；P = 0.002；非 HDS 使用者：调整后的 HR，0.79；95%置信区间，0.68-0.91；P = 0.001）。
在这项亚洲乳腺癌患者的队列研究中，他汀类药物的使用与癌症相关死亡风险降低相关，而与心血管死亡风险无关。我们的研究结果为支持乳腺癌患者使用他汀类药物提供了证据；然而，仍需要随机研究。
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