Study: Statins can lower cancer -related mortality
Study: Statins can lower cancer -related mortality
Reference
Nielsen SF, Nordestgaard BG, Bojesen SE. Statin consumption and reduced cancer -related mortality. n Engl j med . November 8, 2012; 367 (19): 1792-1802.
Design
Danish researchers examined whether the intake of statins is associated with reduced cancer -related mortality before the cancer diagnosis. They examined the mortality of patients from the entire Danish population, in whom a cancer diagnosis was received between 1995 and 2007, with follow -up until December 31, 2009. Of the patients aged 40 or older, 18,721 had been taken regularly before the cancer diagnosis had been taken and 277,204 had never been used.
results
In the case of statin consumers, the risk of dying for any reason or cancer was 15 % lower. The reduced cancer -related mortality under statin consumers was observed for each of the 13 types of cancer.
effects on practice
This study deserves our attention together with several other recent work. If these results are real, we should think about prescribing a lot more of our patients instead of not having to use their use.
In particular, we should think about prescribing patients with breast cancer statins. In April 2013, Dr. Teemu Murtola at the annual conference of the American Association for Cancer Research that the use of statins with a reduction in risk of dying from breast cancer is connected to up to 66 %.
Murtola et al. carried out her retrospective study in which she examined the statin consumption and breast cancer mortality in 31,114 women with breast cancer, in which a diagnosis was made in Finland between 1995 and 2003. 6.011 of women died during the follow -up examination; 3.169 due to breast cancer. The mortality rate for statin consumers was 7.5 %, while it was 21 % in non -tatin consumers.
In other words: In women with localized diseases that take statins, the risk of death was 67 % lower than in non -consumers (risk ratio 0.33). In patients with metastasizing disease, statins reduced the risk of death by 48 % (HR 0.52). Finland's National Health database enabled a detailed analysis, so that the reduced risk of death could be calculated based on the type of statin: including Simvastatin (HR 0.47), Atorvastatin (HR 0.27), Fluvastatin (HR 0.35) and Pravastatin (HR 0.47). 0.50). The middle follow -up period was about 3 years, but fluctuated between less than 1 year and 9 years.
Statins have an image in alternative medical tours that can hardly be shaken. They are often considered the best example of everything that works wrong with Big Pharma. They are considered overpriced medication that are excessively marketed and prescribed, while the risks associated with consumption are underestimated. Therefore, we are obliged to search for other explanations for these results.
nielsen argues that their results are ".... are plausible because statins in cells in cells by inhibiting the 3-hydroxy-3-methylglutaryl-coenzyym-a-reductase (HMGCOA), the speed-determining enzyme in the Mevalonate and cholesterol synthesis. used in cell proliferation because they are required for critical cell functions such as the maintenance of the membrane integrity, signal transmission, protein synthesis and the course of the cell cycle.
plausible yes, but they are still not easy for us to accept. Statins have an image in alternative medical tours that can hardly be shaken. They are often considered the best example of everything that works wrong with Big Pharma. They are considered overpriced medication that are excessively marketed and prescribed, while the risks associated with consumption are underestimated. Therefore, we are obliged to search for other explanations for these results.
siddarth Singh from Mayo Clinic writes in the Mayo edition of the World Journal for Clinical Oncology provides several alternative explanations for Nielsen's results that indicate that several disruptive factors have not been taken into account. On the one hand, data for smoking were not taken into account. Patients may have stopped smoking when they started taking statins, possibly after they had recently suffered a myocardial infarction. Reducing or quitting smoking in statin consumers could lead to a lower risk of mortality.
Another possible explanation is the so-called "health user effect" and also the "health-adherer effect". Doctors can unconsciously prescribe obese patients or smokers due to their unhealthy lifestyle, but selectively too little statins. This could also change mortality.
The third option is the simultaneous taking of other medicines with cancer effect.
In Nielsen's study, women who have statins had earnings, frequent cardiovascular diseases (70 % vs. 21 %) and diabetes (18 % vs. 3 %) as women who do not take any statins. This could have led to a disproportionately higher use of aspirin and metformin in the statin consumers. Both are associated with reduced cancer -related mortality. Nielsen once again checked the data with regard to this possible aspirin consumption and excluded all participants with cardiovascular diseases (the only indication in Denmark for routine aspirin consumption). The analysis showed the same results. 2
Nevertheless, it is difficult to forget that the meta -analysis of 51 randomized controlled studies by Rothwell et al. From 2012 showed that aspirin consumers had a 15 % lower risk of dying from cancer (OR = 0.85; 95 %-KI: 0.76–0.96).
There are other studies that provide data that contradict both the Nielsen and the Murtola study.
A meta -analysis from 2012 on statin consumption and the risk of developing breast cancer showed no significant benefits. "For this analysis, a total of 24 (13 cohorts and 11 case control studies) with more than 2.4 million participants, including 76,759 breast cancer cases, in ... the use of statins and the long-term intake of statins had no significant influence on the risk of breast cancer (rr = 0.99, 95 %-KI = 0.94, 1.04 or rr = rr = 1.03, 95 %-KI = 0.96, 1.11). " 4 Obviously, these results obviously relate to the risk of developing breast cancer, and not at the risk of dying.
It could be argued that statins are actually useful after the breast cancer diagnosis. Swedish data published in April 2013 indicate that there may be a way to predict which types of cancer address statin treatment. Bjarnadottir et al. treated 50 women who diagnosed invasive breast cancer for two weeks before cancer surgery with high -dose atorvastatin (i.e. 80 mg/day). Tissue samples before and after statin therapy were compared. On average, when looking at all the paired samples, the Ki67 expression did not decrease significantly after statin treatment by only 7.6 % ( p = 0.39), but in tumors, the HMG-COA reductase (HMGCR), the speed-determining enzyme of the Mevalonate signal path, express, sank ki67 significantly by 24 % ( p = 0.02). Statins have the strongest anti-proliferative effect in HMGCR-positive tumors. Thus, the examination for HMGCR could offer a possibility to select cancer patients that address them positively to statins and benefit from the treatment. 5 The studies by Nielsen and Murtola are exciting. In the long run, your results can keep or not. The question now is whether we encourage patients, in particular breast cancer patients, to take statin medication or wait a few years in the hope that large, final, prospective, randomized, controlled studies provide final answers. In particular, the data from Murtola are convincing. If this applies, statins can lower the risk of dying from breast cancer than other adjuvant therapies used. Statins cover risks, but these seem to be of less extent than the cancer therapies currently considered routinely. If we weigh up risk and benefit, the scale begins to tip in the direction of the statins. For further research on integrative oncology, click here here.
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