Statins and the risk of pancreatic cancer in Type 2 diabetic patients—A population‐based cohort study

Abstract

The aim of this study was to determine whether statin use exerts a protective effect against pancreatic cancer in Type 2 diabetic patients. A retrospective population-based cohort study was designed to analyze the National Health Insurance Research database (NHIRD) from 1997-2010 in Taiwan. A total of 1,140,617 patients with a first-time diagnosis of Type 2 diabetes were enrolled. The event was defined as newly diagnosed pancreatic cancer. A Cox proportional hazards regression model with time-dependent covariates was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of pancreatic cancer associated with statin use in the diabetic cohort. A total of 2,341 patients with newly diagnosed pancreatic cancer were identified in the diabetic cohort during the follow-up period of 6,968,217.1 person-years. In this cohort, 450,282 patients were defined as statin users (statin use 28 cumulative defined daily dose [cDDD] in 1 year) and 0.14% had pancreatic cancer; 690,335 patients were statin nonusers (statin use <28 cDDD in 1 year) and 0.25% had pancreatic cancer. Statin use significantly decreased the risk of pancreatic cancer (adjusted HRs: 0.78 in 28-83 cDDD per year; 0.48 in 84-180 cDDD per year; and 0.33 in >180 cDDD per year) after adjusting for multiple confounders. There was a significant dose-effect of statin use for the risk of pancreatic cancer (p for trend: <0.001). Statin use may be associated with a reduced risk of pancreatic cancer in Type 2 diabetic patients. More research is needed to clarify this association.Pancreatic cancer is the fourth leading cause of cancer deaths in the United States; approximately 4% of patients survive 5 years after the diagnosis as pancreatic cancer is rarely diagnosed in the resectable phase.1,2 The low survival rate of patients with pancreatic cancer points toward an increased need for novel therapeutics, early detection and chemoprevention strategies. However, the clinical influence of carcinogenesis on pancreatic cancer is multifactorial, including diabetes mellitus (DM), cigarette smoking, heavy alcohol consumption, history of pancreatitis and genetic factors.1,3 Long-standing DM with a >5-year history may result in a 50% increased relative risk of pancreatic cancer compared to those without DM. 4 Metabolic abnormalities significantly increase the risk of pancreatic cancer; the key component of metabolic syndrome related to pancreatic carcinogenesis is thought to be DM. Statins, inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, are considered a first-line medical therapy for hypercholesterolemia. Several studies have implied that statins may possess chemopreventive potential through the inhibition of cell cycle proliferation, induction of apoptosis and suppression of tumor progression.6-8 A case-control study based on a database of 500,000 veterans in the United States showed a 67% risk reduction of pancreatic cancer for those using statins

Chemoprevention and Treatment of Pancreatic Cancer: Update and Review of the Literature

“…Statins are inhibitors of 3-hydroxy-3-methylglutarylcoenzyme A reductase and are used in hypercholesterolemia [124]. The risk for pancreatic cancer is reduced in male smokers (OR 0.11, 95% CI 0.01-0.96, p = 0.05) and not in diabetic patients (OR 0.92, 95% CI 0.35-2.45, p = 0.80) [125].…”

Ectopic Expression of DSCR1 in Conjunction with NDV Infection Reduces VEGF and Induces Apoptosis in Lung Cancer A549 Cell Line

“…[7,8]. This result was possibly a result of hepatitis B carriers' long latency period, and the fact that most patients do not seek for medical treatment at hospitals unless they fall ill; thus, it is likely that there was an insufficient number of patients with hepatitis B in this study, which may have contributed to the nonsignificant difference in these statistical results.…”

The role of statins as therapeutic agents in cancer

“…Concerning the pancreatic cancer (PC), even though not all of the published data are convincing (Bonovas et al 2008;Bradley et al 2010;Chiu et al 2011;Cui et al 2012), in several studies statins have been proven to significantly decrease the PC risk (Khurana et al 2007;Nielsen et al 2012;Walker et al 2015;Chen et al 2016). Lee et al (2016) have shown that statin application was associated with a lower risk of cancer mortality, especially among simvastatin and atorvastatin users.…”