Statins Linked to Lower Cancer Risk in Heart Failure Patients

Kai-Hang Yui, MD, PhD

Registry data from more than 87,000 patients suggests patients with heart failure using statins had a 16% lower risk of developing cancer and a 26% reduced risk of cancer mortality compared to their counterparts not using statin therapy.

Performed by investigators from the University of Hong Kong and the National Heart Center in Singapore, results of the retrospective cohort study also indicate increased length of statin use was associated with even greater reductions in risk of developing cancer.

“Our findings should raise doctors' awareness of the increasing cancer incidence among heart failure patients and encourage them to pay extra attention to non-cardiovascular-related outcomes. Moreover, our study highlights the relationship between heart failure and cancer development, and provides important information regarding the possibility of reducing cancer incidence and related deaths by using statins in these patients,” said Kai-Hang Yiu,MD, PhD, Clinical Associate Professor at the University of Hong Kong, in a statement.

With patients with heart failure at an increased risk of incident cancer and previous research suggesting statin could provide chemoprotective benefits, Yiu and a team of colleagues sought to evaluate associations between statin use and incident cancer in a real-world cohort. Using the Clinical Data Analysis Reporting System, a territory-wide database developed by the Hong Kong Hospital Authority, investigators identified more than 120,000 patients diagnosed with heart failure from 2003-2015 for inclusion in their retrospective cohort study.

After excluding patients with a prior cancer diagnosis, patients who died within 90 days of heart failure diagnosis, patients with an HIV infection, and patients who used statins for fewer than 90 days within the first year after heart failure diagnosis, 87,102 patients were identified for inclusion in the final analytical sample. For the purpose of analysis, exposure to statin therapy was defined as 90 or more days of consecutive use of a statin within the first year following a heart failure diagnosis. Of the 87,102 patients included in the study, 36,176 were considered statin users and 50,926 were considered nonusers.

The primary outcomes of interest for the study were incident cancer and cancer-related mortality. Competing risk regression with Cox proportional hazards models was used to estimate the risk of each associated with statin use. Using patient data from 3 years prior to index date, investigators obtained information related to multiple covariates, including comorbidities, medication history, and lifestyle factors.

The final study cohort had a median age of 76.5±12.8 years and 47.8% were male. Compared to nonusers, statin users were younger (73.7±12.0 vs 78.5±13.0), more likely to be male (51.6% vs 45.1%), more likely to have coronary artery disease (50.7% vs 23.3%), more likely to have dyslipidemia (23.0% vs 5.2%), and more likely to have diabetes (25.9% vs 17.9%).

Over a median follow-up of 4.1 (IQR, 1.6-1.8) years, 11,052 (12.7%) patients were diagnosed with cancer. In multivariable-adjusted analysis, results indicated statin use was associated with a lower risk of cancer incidence when compared to nonuse (SHR, 0.84; 95% CI, 0.80-0.89).

Further analysis suggested this apparent inverse association with risk of cancer was duration dependent. Compared to those reporting short-term use of statin therapy, which was defined as 3 months to less than 2 years, the adjusted SHR for those reporting using of use lasting 2 to less than 4 years was 0.99 (95% CI, 0.87-1.13), 0.82 (95% CI, 0.70-0.97) for those reporting use lasting 4 to less than 6 years, and 0.78 (95% CI, 0.65-0.93) for those reporting use lasting 6 years or more.

When assessing cancer-related mortality, 10-year cancer-related mortality rates were 3.8% among statin users and 5.2% among nonusers. In adjusted analysis, statin use was significantly associated with a lower risk of cancer-related death (SHR, 0.74; 95% CI, 0.67-0.81). Investigators also pointed out the 10-year risk of all-cause mortality was significantly reduced among statin users, with a 38% lower risk in adjusted analysis (HR, 0.62; 95% CI, 0.61-0.64).

"Randomized trials should be carried out to investigate this further. In addition, the findings, combined with previous research showing the strong association between heart failure and cancer, call for potential strategies to reduce the risk of cancer, such as screening for cancer in heart failure patients,” added Yiu.

This study, “Statin associated lower cancer risk and related mortality in patients with heart failure,” was published in the European Heart Journal.