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

Abstract

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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