Use of statins is linked to reduced risk of cancer in patients with heart failure

Abstract graphic. Credit: European Heart Journal

The use of statins in patients with heart failure is associated with a 16% lower risk of developing cancer compared to non-statin users during an average of four years of follow-up, according to a new study published today. hui (wednesday) in the European Heart Journal.

What’s more, the study found that statin use was associated with a 26% reduction in the risk of dying from cancer during the same time period.

Previous research has shown that heart failure patients are at increased risk of developing cancer, possibly because heart the failure may be a carcinogenic disease via shared pathways such as inflammation or genetic factors. However, there have been very few studies on associations between statin use and the risk of developing and dying from cancer in patients with heart failure. The current observational study of more than 87,000 people in Hong Kong is the largest study to investigate this topic and the authors believe their findings can be extrapolated to other populations.

The study also found that the longer people with heart failure took statins, the lower their risk of developing cancer. Compared to taking statins for between three months and two years and after adjusting for factors that might affect outcome such as age, sex, smoking, alcohol use, and other health issues, if patients remained on statins for four and six years, their risk was reduced by 18% and if they took them for six years or more, the risk was reduced by 22%.

Likewise, the risk of dying from cancer was reduced by 33% and 39% if patients remained on statins for four to six years and for six years or more respectively, compared to patients who took statins between three months and two years. .

Dr Kai-Hang Yiu, University of Hong Kong, who led the study, said, “Ten years after starting statins, cancer deaths were 3.8% in patients with d. heart failure taking statins and 5.2% in nonusers, a reduction in the absolute risk of death of 1.4%. The reduction in the absolute risk of developing cancer after six years on statins was 22% lower than those who received only three months to two years of statins.

In collaboration with Professor Carolyn Lam, from the National Heart Center, Singapore, and other researchers, Dr Yiu analyzed data from 87,102 patients in Hong Kong who were hospitalized for heart failure between 2003 and 2015. The patients have been followed until diagnosed. has cancer, is deceased or until the end of 2018, whichever occurs first. Patients were excluded from the study if they had a history of cancer or were diagnosed or died within 90 days of the first diagnosis of heart failure, if they had HIV, or if they had taken statins for less than 90 days. This left 36,176 statin users and 50,926 non-statin users for analysis.

A total of 3,863 (4.4%) of patients died of cancer during follow-up and the most common types of cancer were intestines, stomach, lungs, liver, and bile ducts (liver ).

The researchers also found that deaths from any cause were lower in statin users compared to non-users: by ten years, 60.5% (21,886) of statin users had died and 78.8% (40,130) of non-statin users had died, meaning that statin use was associated with a 38% reduction in all-cause deaths compared to non-users.

Researchers say advances in the treatment of heart failure, which doubled five-year survival rates from 29% to 60% between 1970 and 2009, have been offset by an increase in deaths from other causes, especially cancer. , in patients with heart failure.

Dr Yiu said, “Heart failure is a growing disease around the world and deaths from other causes unrelated to the heart and blood vessels are of concern. Our findings should raise awareness among physicians about the increasing incidence of cancer in heart failure patients and encourage them to pay special attention to non-cardiovascular outcomes.In addition, our study highlights the relationship between heart failure and heart failure. the development of cancer, and provides important information regarding the possibility of reducing the incidence of cancer and associated deaths by using statins in these patients.

Randomized trials should be conducted to investigate this question further. In addition, the results, combined with previous research showing the strong association between heart failure and cancer, call for potential strategies to reduce cancer risk, such as cancer screening in heart failure the patients.”

Strengths of the study include its size, use of data from a well validated territory-wide electronic health database, and adjustment for factors that might affect outcomes, including use of drugs such as metformin and aspirin which are known to protect against cancer.

Limitations include the fact that this is a non-randomized observational study, which means that it can only show an association between statins and a lower cancer risk and not that statins lead to the reduction. risk; information about factors that could affect the risk of Cancer, like family history, was not available; there could be other factors that could affect the results that were not included in the analyzes; and there was no information on the quality of the heart left ventricle worked and therefore it was not possible to assess the potential protective effects of use of statins on the left ventricular ejection fraction.