Department of General Surgery, Tays Cancer Centre, Tampere, Finland.
Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
JAMA Netw Open. 2023 Nov 1;6(11):e2343861. doi: 10.1001/jamanetworkopen.2023.43861.
Several studies have reported an association between the use of statins and breast cancer (BC) mortality. However, most of these studies did not take into account the underlying cholesterol level.
To investigate the association between serum cholesterol, statin use, and BC mortality.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included females with invasive BC that was newly diagnosed between January 1, 1995, and December 31, 2013, in Finland. The cohort had available hormone receptor data and at least 1 cholesterol measurement. All data were obtained from Finnish national registries. Statistical analyses were performed from January to May 2022.
Use of statins; statin dose; and serum cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels measured separately before and after BC diagnosis.
Breast cancer mortality and overall mortality between date of BC diagnosis and December 31, 2015.
A total of 13 378 female patients with BC (median [IQR] age, 62 [54-69] years) participated in the study. The median (IQR) follow-up was 4.5 (2.4-9.8) years after BC diagnosis, during which 16.4% of patients died and 7.0% died of BC. Prediagnostic statin use was a risk factor for BC death even after adjustment for total cholesterol level (hazard ratio [HR], 1.22; 95% CI, 1.02-1.46; P = .03). Reduced risk for BC death was seen for postdiagnostic statin use (HR, 0.85; 95% CI, 0.73-1.00; P = .05). The risk reduction was robust in participants whose cholesterol level decreased after starting statins (HR, 0.49; 95% CI, 0.32-0.75; P = .001) but was nonsignificant if cholesterol level did not subsequently decrease (HR, 0.69; 95% CI, 0.34-1.40; P = .30). Reduced BC mortality among statin users was also observed in females with estrogen receptor-positive tumors (HR, 0.82; 95% CI, 0.68-0.99; P = .03). Overall mortality was lower among statin users vs nonusers when adjusted for serum cholesterol level (HR, 0.80; 95% CI, 0.72-0.88; P < .001).
Results of this cohort study showed that postdiagnostic use of statins was associated with reduced BC mortality compared with nonuse, and the risk was associated with subsequent change in serum cholesterol level. This finding suggests that cholesterol-lowering interventions with statins may be beneficial for patients with BC.
几项研究报告了他汀类药物的使用与乳腺癌（BC）死亡率之间存在关联。然而，这些研究大多没有考虑到潜在的胆固醇水平。
研究血清胆固醇、他汀类药物使用与 BC 死亡率之间的关系。
设计、设置和参与者：本队列研究纳入了芬兰 1995 年 1 月 1 日至 2013 年 12 月 31 日期间新诊断为浸润性 BC 的女性。该队列有激素受体数据和至少 1 次胆固醇测量值。所有数据均来自芬兰国家登记处。统计分析于 2022 年 1 月至 5 月进行。
他汀类药物的使用；他汀类药物的剂量；以及 BC 诊断前和诊断后分别测量的血清胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯水平。
BC 诊断日期至 2015 年 12 月 31 日的乳腺癌死亡率和总死亡率。
共纳入 13378 名患有 BC 的女性患者（中位[IQR]年龄，62[54-69]岁）。BC 诊断后中位（IQR）随访时间为 4.5（2.4-9.8）年，在此期间，16.4%的患者死亡，7.0%死于 BC。即使在校正总胆固醇水平后，预诊断他汀类药物使用也是 BC 死亡的危险因素（风险比[HR]，1.22；95%CI，1.02-1.46；P = 0.03）。使用他汀类药物后，BC 死亡风险降低（HR，0.85；95%CI，0.73-1.00；P = 0.05）。如果胆固醇水平随后没有降低，则风险降低不显著（HR，0.69；95%CI，0.34-1.40；P = 0.30），但在开始使用他汀类药物后胆固醇水平降低的参与者中，风险降低是稳健的（HR，0.49；95%CI，0.32-0.75；P = 0.001）。在雌激素受体阳性肿瘤的女性中，他汀类药物使用者的 BC 死亡率也较低（HR，0.82；95%CI，0.68-0.99；P = 0.03）。在校正血清胆固醇水平后，与非使用者相比，他汀类药物使用者的总死亡率较低（HR，0.80；95%CI，0.72-0.88；P < 0.001）。
本队列研究结果表明，与不使用他汀类药物相比，使用他汀类药物后与 BC 死亡率降低有关，风险与随后的血清胆固醇水平变化有关。这一发现表明，他汀类药物降低胆固醇的干预措施可能对 BC 患者有益。
