statin risks cancer and cognitive dysfunction

Statins & cancer risk

Methods:• A retrospective cohort analysis of cancer incidence in older

adults who have and who have not used statins was performed in11 million analyzable patient records from January 1990 through February 2009 drawn from the General Electric Centricity electronic medical records database

Results: • After matching, the incidence of cancer in patients taking a

statin was 11.37% compared with 11.11% in matched patients not taking a statin

Conclusion:• There is no statistically significant increased risk of cancer

associated with statins

Cai H, Zhang G, Wang Z, Luo Z, Zhou X (2015) Relationship Between the Use of Statins and Patient Survival in Colorectal Cancer: A Systematic Review and Meta-Analysis. PLoS ONE 10(6): e0126944

• PubMed and Embase databases for relevant studies published up to September 2014 that assessed statin use and CRC prognosis

• The primary outcomes were overall survival (OS) and cancer-specific survival (CSS).

Results

30% reduction in CRC-specific mortality

24% reduction in overall mortality

• Retrospective observational study

• 22,000 high-risk prostate cancer patients who were receiving statin or metformin or both (CSM=combination statin metformin)

• Stratification done based on presence or absence of obesity/metabolic syndrome

• Aim: To examine the association between treatment with CSM and prostate cancer specific mortality (PCSM) by obesity/MetS status

American Society of Clinical Oncology (ASCO) 2015 Annual Meeting: Abstracts 1506 and 5018. Presented May 30, 2015.

Results43% reduction in cancer risk with combined use

Even when statins are used alone,

there is 40% reduction in risk

Conclusion

Both statin use alone and in combination with metformin are associated with a reduction in prostate cancer specific mortality

American Society of Clinical Oncology (ASCO) 2015 Annual Meeting: Abstracts 1506 and 5018. Presented May 30, 2015.

• Aim: To investigate the association between statin use and all-cancer mortality in a prospective cohort of postmenopausal women

• Data taken from Women’s Health Initiative Observational Study

• Subjects were 1,46,326 postmenopausal women aged 50 to 79 years who were enrolled between 1993 and 1998

• Association between patients' never having used statins, current statin use, and past statin use, as well as the incidence and number of deaths from cancer was determined over a mean follow-up period of 14 years

• Confounding factors, including age, race/ethnicity, education, smoking, physical activity, family history of cancer were accounted for

23%

43%

40%Overall cancer mortality

Breast cancer

Colorectal cancer

Results

Risk reduction was independent of statin

potency, lipophilicity/hydroph

ilicity, type, or duration

Current statin use was associated with risk reduction in :

42%Ovarian cancer

Conclusion: In a cohort of postmenopausal women, regular use of statins or other lipid-lowering medications may decrease cancer mortality, regardless of the type, duration, or potency of statin medications used

• Historically, there has always been a concern that statins affect cognition

• In February 2012, FDA changes in labeling for statins about reversible changes such as ill-defined memory loss and confusion which was applicable to all statins

Swiger KJ. Mayo Clin Proc. 2013 Nov;88(11):1213-21

• Like other non-cardiovascular effects, statin-induced cognitive dysfunction has a mixed body of evidence

• While some past studies have shown negative effect on cognition, they have been controversial and are of low methodological quality

• Since then, however, evidence has mounted in support of statins having a protective effect against dementia

• This has been attributed to the inhibition of mevalonate production in the CNS by statins

Shah NP et al. Curr Atheroscler Rep. 2015 Jan;17(1):466

Data from meta-analysis-1

Data from meta-analysis-2

Recommendations for practice

• According to FDA data, adverse event reporting rates for dementia are similar among statins, losartan and clopidogrel

• At present, patients and physicians can be reassured about concerns related to neurocognitive effects of statin therapy, and the evidence does not support a change to practice guidelines

Richardson K et al. Ann Intern Med. 2013 Nov 19;159(10):688-97Swiger KJ. Mayo Clin Proc. 2013 Nov;88(11):1213-21