Association between statin use and colorectal cancer risk: a meta-analysis of 42 studies

Liu, Yanqiong; Tang, Weizhong; Wang, Jian; Xie, Li; Li, Taijie; He, Yu; Deng, Yan; Peng, Qiliu; Li, Shan; Qin, Xue

doi:10.1007/s10552-013-0326-6

Cited by 116 publications

(97 citation statements)

References 74 publications

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“…Any benefit from lifestyle changes can be augmented by regular intake of aspirin and other nonsteroidal anti-inflammatory drugs 33 ; however, this effect seems to depend on host genotype 34,35 . Statin use might have a small preventive effect on colorectal cancer incidence 36,37 , as does hormone therapy in post-menopausal women 38 .…”

Section: Epidemiologymentioning

confidence: 99%

Colorectal cancer

Kuipers

Grady

Lieberman

et al. 2015

Nat Rev Dis Primers

1,303

1,062

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Colorectal cancer had a low incidence several decades ago. However, it has become a predominant cancer and now accounts for approximately 10% of cancer-related mortality in western countries. The ‘rise’ of colorectal cancer in developed countries can be attributed to the increasingly ageing population, unfavourable modern dietary habits and an increase in risk factors such as smoking, low physical exercise and obesity. New treatments for primary and metastatic colorectal cancer have emerged, providing additional options for patients; these treatments include laparoscopic surgery for primary disease, more-aggressive resection of metastatic disease (such as liver and pulmonary metastases), radiotherapy for rectal cancer and neoadjuvant and palliative chemotherapies. However, these new treatment options have had limited impact on cure rates and long-term survival. For these reasons, and the recognition that colorectal cancer is long preceded by a polypoid precursor, screening programmes have gained momentum. This Primer provides an overview of the current state of art knowledge on the epidemiology and mechanisms of colorectal cancer, as well as on diagnosis and treatment.

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Section: Epidemiologymentioning

confidence: 99%

Colorectal cancer

Kuipers

Grady

Lieberman

et al. 2015

Nat Rev Dis Primers

1,303

1,062

View full text Add to dashboard Cite

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“…They are among the most commonly used drugs for treatment of hypercholesterolemia and reduction of cardiovascular risk 22 . However studies have suggested an intriguing potential benefit by reducing cancer incidence, in particular, colorectal cancer 22–25 . Most prior studies have focused on sporadic colon cancer with only one prior study demonstrating an inverse association between statin use and IBD-related neoplasia 26 .…”

Section: Introductionmentioning

confidence: 99%

Statin Use Is Associated With Reduced Risk of Colorectal Cancer in Patients With Inflammatory Bowel Diseases

Ananthakrishnan

Cagan

Cai

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis are associated with an increased risk of colorectal cancer (CRC). Chemopreventive strategies have produced weak or inconsistent results. Statins have been inversely associated with sporadic CRC. We examined their role as chemopreventive agents in patients with IBD. Methods We collected data from 11,001 patients with IBD receiving care at hospitals in the Greater Boston metropolitan area from 1998 through 2010. Diagnoses of CRC were determined using validated ICD-9-CM codes. Statin use prior to diagnosis was assessed through analysis of electronic prescriptions. We performed multivariate logistic regression analyses, adjusting for potential confounders including primary sclerosing cholangitis, smoking, increased levels of inflammation markers, and CRC screening practices to identify independent association between statin use and CRC. We performed sensitivity analyses using propensity score adjustment and variation in definition of statin use. Results In our cohort 1376 of the patients (12.5%) received 1 or more prescriptions for a statin. Patients using statins were more likely to be older, male, white, smokers, and have greater comorbidity than non-users. Over a follow-up period of 9 years, 2% of statin users developed CRC compared to 3% of non-users (age-adjusted odds ratio, 0.35; 95% confidence interval, 0.24–0.53). On multivariate analysis, statin use remained independently and inversely associated with CRC (odds ratio, 0.42; 95% confidence interval, 0.28–0.62). Our findings were robust on a variety of sensitivity and subgroup analyses. Conclusions Statin use is inversely associated with risk of CRC in a large IBD cohort. Prospective studies on the role of statins as chemopreventive agents are warranted.

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“…We were also not convinced that there would be a sufficient number of initiators in the data. Statins were excluded because there is ongoing debate as to whether they are associated with cancer risk[65, 66]. There is a substantial body of evidence on anti-hypertensives (AHT), enough to state with some certainty that they do not dramatically alter CRC risk, and limited evidence that some may reduce risk[67], with the exception of beta-blockers where evidence suggests a reduced cancer risk[68].…”

Section: Case Study: Antidepressants and Colorectal Cancermentioning

confidence: 99%

The importance and implications of comparator selection in pharmacoepidemiologic research

2018

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Purpose of review: Pharmacoepidemiologic studies employing large databases are critical to evaluating the effectiveness and safety of drug exposures in large and diverse populations. Because treatment is not randomized, researchers must select a relevant comparison group for the treatment of interest. The comparator group can consist of individuals initiating: (1) a similarly indicated treatment (active comparator), (2) a treatment used for a different indication (inactive comparator) or (3) no particular treatment (non-initiators). Herein we review recent literature and describe considerations and implications of comparator selection in pharmacoepidemiologic studies. Recent findings: Comparator selection depends on the scientific question and feasibility constraints. Because pharmacoepidemiologic studies rely on the choice to initiate or not initiate a specific treatment, rather than randomization, they are at-risk for confounding related to the comparator choice including: by indication, disease severity and frailty. We describe forms of confounding specific to pharmacoepidemiologic studies and discuss each comparator along with informative examples and a case study. We provide commentary on potential issues relevant to comparator selection in each study, highlighting the importance of understanding the population in whom the treatment is given and how patient characteristics are associated with the outcome. Summary: Advanced statistical techniques may be insufficient for reducing confounding in observational studies. Evaluating the extent to which comparator selection may mitigate or induce systematic bias is a critical component of pharmacoepidemiologic studies.

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Association between statin use and colorectal cancer risk: a meta-analysis of 42 studies

Abstract: Our results suggest that statin use is associated with a modest reduced risk of CRC; apparent associations were found for lipophilic statin use. However, long-term statin use did not appear to significantly affect the risk of CRC.

Cited by 116 publications

References 74 publications

Colorectal cancer

Colorectal cancer

Statin Use Is Associated With Reduced Risk of Colorectal Cancer in Patients With Inflammatory Bowel Diseases

The importance and implications of comparator selection in pharmacoepidemiologic research

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