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Statins and Cancer Risk A Meta-analysis

Krista M. Dale, PharmD; Craig I. Coleman, PharmD; Nickole N. Henyan, PharmD; Jeffrey Kluger, MD; C. Michael White, PharmD
JAMA. 2006;295(1):74-80. doi:10.1001/jama.295.1.74.
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Published online

Context Statins are cholesterol-lowering drugs that have been proven in randomized controlled trials to prevent cardiac events. Recent retrospective analyses have suggested that statins also prevent cancer.

Objectives To investigate the effect of statin therapy on cancer incidence and cancer death and to analyze the effect of statins on specific cancers and the effect of statin lipophilicity or derivation.

Data Sources A systematic literature search of MEDLINE, EMBASE, CINAHL, Web of Science, CANCERLIT, and the Cochrane Systematic Review Database through July 2005 was conducted using specific search terms. A review of cardiology and cancer abstracts and manual review of references was also performed.

Study Selection Twenty-seven of the 8943 articles (n = 86 936 participants) initially identified met the inclusion criteria, reporting 26 randomized controlled trials of statins, with a mean duration of follow-up of at least 1 year, enrolling a minimum of 100 patients, and reporting data on either cancer incidence (n = 20 studies) or cancer death (n = 22 studies).

Data Extraction All data were independently extracted by 3 investigators using a standardized data abstraction tool. Weighted averages were reported as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model (DerSimonian and Laird methods). Statistical heterogeneity scores were assessed with the Q statistic.

Data Synthesis In meta-analyses including 6662 incident cancers and 2407 cancer deaths, statins did not reduce the incidence of cancer (OR, 1.02; 95% CI, 0.97-1.07) or cancer deaths (OR, 1.01; 95% CI, 0.93-1.09). No reductions were noted for any individual cancer type. This null effect on cancer incidence persisted when only hydrophilic, lipophilic, naturally derived, or synthetically derived statins were evaluated.

Conclusions Statins have a neutral effect on cancer and cancer death risk in randomized controlled trials. We found that no type of cancer was affected by statin use and no subtype of statin affected the risk of cancer.

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Figures

Figure 1. Trial Identification, Inclusion, and Exclusion
Graphic Jump Location

Asterisk indicates some studies reported more than 1 type of cancer; therefore, cancer subtypes add up to more than 20.

Figure 2. Cancer Incidence
Graphic Jump Location

See Table 1 abbreviations footnote for study name expansions. The size of the data markers represents the relative weight of the trial according to size and occurrence of the outcome being measured.

Figure 3. Cancer Death
Graphic Jump Location

See Table 1 abbreviations footnote for study name expansions. The size of the data markers represents the relative weight of the trial according to size and occurrence of the outcome being measured. Odds ratio calculations were not possible for 3 of the 22 studies due to no deaths in their control groups and, thus, are not shown here.

Figure 4. L’Abbe Plots for Cancer Incidence and Cancer Death
Graphic Jump Location

Data marker size represents sample size. Plots represent data from 20 studies of cancer incidence and 22 studies of cancer death.

Figure 5. Funnel Plots for Cancer Incidence and Cancer Death
Graphic Jump Location

Plots represent data from 20 studies of cancer incidence and 22 studies of cancer death.

Tables

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