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Schmidt S, Schmidt M, Mehnert F, Lemeshow S, Sørensen H. Use of antihypertensive drugs and risk of skin cancer. J Eur Acad Dermatol Venereol 2015; 29:1545-54. [DOI: 10.1111/jdv.12921] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/18/2014] [Indexed: 12/25/2022]
Affiliation(s)
- S.A.J. Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
- Division of Biostatistics; College of Public Health; Ohio State University; Columbus OH USA
| | - M. Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
- Division of Biostatistics; College of Public Health; Ohio State University; Columbus OH USA
| | - F. Mehnert
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - S. Lemeshow
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
- Division of Biostatistics; College of Public Health; Ohio State University; Columbus OH USA
| | - H.T. Sørensen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
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102
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Ahern TP, Lash TL, Damkier P, Christiansen PM, Cronin-Fenton DP. Statins and breast cancer prognosis: evidence and opportunities. Lancet Oncol 2015; 15:e461-8. [PMID: 25186049 DOI: 10.1016/s1470-2045(14)70119-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Much preclinical and epidemiological evidence supports the anticancer effects of statins. Epidemiological evidence does not suggest an association between statin use and reduced incidence of breast cancer, but does support a protective effect of statins--especially simvastatin--on breast cancer recurrence. Here, we argue that the existing evidence base is sufficient to justify a clinical trial of breast cancer adjuvant therapy with statins and we advocate for such a trial to be initiated without delay. If a protective effect of statins on breast cancer recurrence is supported by trial evidence, then the indications for a safe, well tolerated, and inexpensive treatment can be expanded to improve outcomes for breast cancer survivors. We discuss several trial design opportunities--including candidate predictive biomarkers of statin safety and efficacy--and offer solutions to the key challenges involved in the enrolment, follow-up, and analysis of such a trial.
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Affiliation(s)
- Thomas P Ahern
- Departments of Surgery and Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA.
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Peer M Christiansen
- Unit of Breast and Endocrine Surgery, Aarhus University Hospital, Aarhus, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
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103
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Fujimoto M, Higuchi T, Hosomi K, Takada M. Association between statin use and cancer: data mining of a spontaneous reporting database and a claims database. Int J Med Sci 2015; 12:223-33. [PMID: 25678839 PMCID: PMC4323360 DOI: 10.7150/ijms.10656] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/07/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE In recent years, the potential risk of cancer associated with statin use has been a focus of much interest. However, it remains uncertain whether statin therapy is associated with cancer risk. To examine the association between statin use and the risk of cancer, we conducted data mining using the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and a large organized database of claims constructed by a database vendor (The Japan Medical Data Center Co., Ltd, Tokyo, Japan [JMDC]). METHODS Relevant reports in the FAERS, which included data from the first quarter of 2004 through the end of 2012, were identified and analyzed. The reporting odds ratio (ROR) was used to detect spontaneous report signals and was calculated using the case/non-case method. Additionally, signals were detected via the information component (IC) using the IC025 metric. Furthermore, event sequence symmetry analysis (ESSA) was applied to identify the risk of cancer following treatment with statins over the period January 2005 to July 2013. RESULTS In the FAERS database analyses, significant signals for colorectal cancer and pancreatic cancer were found for statins as a class. In the ESSA, significant associations between statin use and colorectal cancer and pancreatic cancer were found, with adjusted sequence ratios (95% confidence intervals) of 1.20 (1.08-1.34) and 1.31 (1.13-1.53), respectively, at an interval of 48 months. CONCLUSIONS Multi-methodological approaches using different algorithms and databases suggest that statin use is associated with an increased risk for colorectal cancer and pancreatic cancer.
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Affiliation(s)
- Mai Fujimoto
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
| | - Tomoya Higuchi
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
| | - Kouichi Hosomi
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
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104
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Simon TG, King LY, Zheng H, Chung RT. Statin use is associated with a reduced risk of fibrosis progression in chronic hepatitis C. J Hepatol 2015; 62:18-23. [PMID: 25135867 PMCID: PMC4272642 DOI: 10.1016/j.jhep.2014.08.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/20/2014] [Accepted: 08/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Therapies that slow fibrosis progression in chronic liver disease are needed. Animal models have demonstrated that statins prevent the progression of hepatic fibrosis, but human data is lacking so far. We evaluated the association between statins and fibrosis progression in the HALT-C trial cohort. METHODS Subjects with chronic hepatitis C (CHC) and advanced hepatic fibrosis underwent serial liver biopsies over 3.5 years. The primary outcome was a ⩾ 2-point increase in the Ishak fibrosis score on at least one of two serial biopsies. We used complementary log-log regression analysis to assess the association between statins and fibrosis progression among subjects without baseline cirrhosis. RESULTS Fibrosis progression occurred in 3/29 (10%) statin users and 145/514 (29%) non-users. The unadjusted hazard ratio (HR) for fibrosis progression among statin users compared to non-users was 0.32 (95% CI 0.10-0.99). This association remained significant after adjusting for established predictors of histological outcome, including body mass index, platelets and hepatic steatosis (adjusted HR 0.31; 95% CI 0.10-0.97). The mean change in Ishak fibrosis score over the 3.5 year study period was -0.34 (SE 0.18) for statin users compared to +0.42 (SE 0.07) for non-users (p = 0.006, after adjustment for baseline fibrosis score). CONCLUSIONS Statin use is associated with a reduced risk of fibrosis progression in advanced CHC. Our findings suggest a potential role for statins in preventing liver disease progression.
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Affiliation(s)
- Tracey G. Simon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Lindsay Y. King
- Liver Center, Gastrointestinal Division, Department of Medicine, Boston, MA,Harvard Medical School, Boston, MA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Division, Department of Medicine, Boston, MA,Harvard Medical School, Boston, MA
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105
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Zhang XL, Liu M, Qian J, Zheng JH, Zhang XP, Guo CC, Geng J, Peng B, Che JP, Wu Y. Statin use and risk of kidney cancer: a meta-analysis of observational studies and randomized trials. Br J Clin Pharmacol 2014; 77:458-65. [PMID: 23879311 DOI: 10.1111/bcp.12210] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 07/15/2013] [Indexed: 12/16/2022] Open
Abstract
AIM Clinical studies have shown that statin use may modify the risk of kidney cancer. However, these studies yielded different results. To quantify the association between statin use and risk of kidney cancer, we performed a detailed meta-analysis of published studies regarding this subject. METHODS A literature search was carried out using MEDLINE, EMBASE and the Cochrane database between January 1966 and October 2012. Prior to performing a meta-analysis, the studies were evaluated for publication bias and heterogeneity. Fixed effect and random effect models were used to estimate summary relative risks (RR) and the corresponding 95% confidence intervals (CIs). Subgroup analyses and sensitivity analysis were also performed. RESULTS A total of 12 (two randomized controlled trials, five cohort, and five case-control) studies contributed to the analysis. There was heterogeneity among the studies but no evidence of publication bias. Pooled results indicated a non-significant decrease of total kidney cancer risk among all statin users (RR = 0.92, 95% CI 0.71, 1.19). Long term statin use did not significantly affect the risk of total kidney cancer (RR = 1.01, 95% CI 0.83, 1.22). In our subgroup analyses, the results were not substantially affected by study design, confounder adjustment and gender. Furthermore, sensitivity analysis confirmed the stability of the results. CONCLUSION The findings of this meta-analysis suggested that there was no association between statin use and risk of kidney cancer. More studies, especially randomized controlled trials and high quality cohort studies with larger sample size and well controlled confounding factors, are needed to confirm this association in the future.
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Affiliation(s)
- Xiao-long Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China; Department of First Clinical Medical College, Nanjing Medical University, Nanjing, China
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106
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Braeuning A, Bucher P, Hofmann U, Buchmann A, Schwarz M. Chemically induced mouse liver tumors are resistant to treatment with atorvastatin. BMC Cancer 2014; 14:766. [PMID: 25319454 PMCID: PMC4203962 DOI: 10.1186/1471-2407-14-766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/09/2014] [Indexed: 02/06/2023] Open
Abstract
Background Atorvastatin is a potent inhibitor of the mevalonate pathway and widely used as a hypolipidemic drug. Some epidemiological studies and animal experiments indicate that the long-term use of atorvastatin and structurally related drugs might be associated with a reduced risk of developing hepatocellular carcinoma (HCC), the most common hepatocellular malignancy in humans. However, the potential of atorvastatin to inhibit HCC formation is controversially discussed. Methods Hepatocellular tumors were chemically induced by treatment of C3H/He mice with 10 μg/g body weight N-nitrosodiethylamine and the ability of atorvastatin to interfere with tumor formation was investigated by treatment of mice with 0.1% atorvastatin in the diet for 6 months. Tumor size and tumor multiplicity were analyzed, as were tissue levels of cholesterol and atorvastatin. Results Atorvastatin treatment efficiently reduced serum cholesterol levels. However, the growth of tumors driven by activated MAPK (mitogen-activated protein kinase) signaling was not attenuated by the presence of the drug, as evidenced by a lack of reduction of tumor volume or tumor multiplicity by atorvastatin. Levels of the atorvastatin uptake transporters Oatp1a4 and Oatp1b2 were down-regulated at the mRNA and protein levels in chemically induced mouse liver tumors, but without striking effects on atorvastatin concentrations in the tumor tissue. Conclusion In summary, the present data provide substantial evidence that atorvastatin does not beneficially influence tumor growth in mouse liver and thereby challenge the hypothesis that statin use might protect against hepatocellular cancer. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-766) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Albert Braeuning
- Institute of Experimental and Clinical Pharmacology and Toxicology, Department of Toxicology, University of Tuebingen, Wilhelmstr, 56, Tuebingen 72074, Germany.
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107
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Statin use and risk of nonmelanoma skin cancer: a nationwide study in Denmark. Br J Cancer 2014; 112:153-6. [PMID: 25290087 PMCID: PMC4453598 DOI: 10.1038/bjc.2014.527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/20/2014] [Accepted: 09/09/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Evidence is conflicting regarding statin use and risk of basal cell (BCC) and squamous cell skin cancer (SCC). METHODS Using Danish nationwide registries, we identified all patients with incident BCC/SCC during 2005-2009 and matched them to population controls. We computed odds ratios (ORs) for BCC and SCC associated with statin use. RESULTS We identified 38,484 cases of BCC and 3724 cases of SCC. Statin ever use was associated with ORs of 1.09 (CI: 1.06-1.13) for BCC and 1.01 (CI: 0.91-1.11) for SCC. CONCLUSIONS Statin use was not associated with risk of SCC. Residual confounding plausibly explains the marginally increased risk of BCC.
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108
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Shi M, Zheng H, Nie B, Gong W, Cui X. Statin use and risk of liver cancer: an update meta-analysis. BMJ Open 2014; 4:e005399. [PMID: 25227628 PMCID: PMC4166249 DOI: 10.1136/bmjopen-2014-005399] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Statins are commonly prescribed cholesterol-lowering drugs. Preclinical studies suggest that statins may possess cancer preventive properties. The primary objective of this meta-analysis was to determine the association between statin use and risk of liver cancer. DESIGN Meta-analysis. SETTING International. PARTICIPANTS A comprehensive literature search of PubMed, BIOSIS Previews, Web of Science, EMBASE, EBSCO and Cochrane Library was conducted through March 2014. The effect estimate was reported as pooled relative risk (RR) with 95% CIs, using the random-effects model. RESULTS A total of 12 studies (1 individual patient data analysis of 22 randomised controlled trials, 5 cohorts and 6 case-controls) were qualified for this meta-analysis, involving 5,640,313 participants including 35,756 liver cancer cases. Our results indicated a significant risk reduction of liver cancer among all statin users (RR=0.58, 95% CIs 0.51 to 0.67). The difference of the study designs can partly explain the significant heterogeneity found in the overall analysis (I(2)=65%, p=0.0006). No evidence of publication bias was observed in this meta-analysis. Similar risk reductions were found in the subgroups analysis of Western and Asian countries, lipophilic and hydrophilia statins. There was a trend towards more risk reductions in subgroups with higher baseline risk, inadequate adjustment and higher cumulative dosage of statin use. CONCLUSIONS This meta-analysis suggests that statin is associated with a significant risk reduction of liver cancer when taken daily for cardiovascular event prevention. However, this preventive effect might be overestimated due to the exposure period, the indication and contraindication of statins and other confounders. Statins might be considered as an adjuvant in the treatment of liver cancer.
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Affiliation(s)
- Meng Shi
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huiling Zheng
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biao Nie
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Gong
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaobing Cui
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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109
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Allott EH, Howard LE, Cooperberg MR, Kane CJ, Aronson WJ, Terris MK, Amling CL, Freedland SJ. Postoperative statin use and risk of biochemical recurrence following radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2014; 114:661-6. [PMID: 24588774 DOI: 10.1111/bju.12720] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the effect of statin use after radical prostatectomy (RP) on biochemical recurrence (BCR) in patients with prostate cancer who never received statins before RP. PATIENTS AND METHODS We conducted a retrospective analysis of 1146 RP patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Multivariable Cox proportional hazards analyses were used to examine differences in risk of BCR between post-RP statin users vs nonusers. To account for varying start dates and duration of statin use during follow-up, post-RP statin use was treated as a time-dependent variable. In a secondary analysis, models were stratified by race to examine the association of post-RP statin use with BCR among black and non-black men. RESULTS After adjusting for clinical and pathological characteristics, post-RP statin use was significantly associated with 36% reduced risk of BCR (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.47-0.87; P = 0.004). Post-RP statin use remained associated with reduced risk of BCR after adjusting for preoperative serum cholesterol levels. In secondary analysis, after stratification by race, this protective association was significant in non-black (HR 0.49, 95% CI 0.32-0.75; P = 0.001) but not black men (HR 0.82, 95% CI 0.53-1.28; P = 0.384). CONCLUSION In this retrospective cohort of men undergoing RP, post-RP statin use was significantly associated with reduced risk of BCR. Whether the association between post-RP statin use and BCR differs by race requires further study. Given these findings, coupled with other studies suggesting that statins may reduce risk of advanced prostate cancer, randomised controlled trials are warranted to formally test the hypothesis that statins slow prostate cancer progression.
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Affiliation(s)
- Emma H Allott
- Division of Urology, Department of Surgery, Duke University School of Medicine, NC, USA; Cancer Prevention, Detection and Control Program, Duke Cancer Institute, NC, USA; Division of Urology, Veterans Affairs Medical Center Durham, NC, USA
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110
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Hahn VS, Lenihan DJ, Ky B. Cancer therapy-induced cardiotoxicity: basic mechanisms and potential cardioprotective therapies. J Am Heart Assoc 2014; 3:e000665. [PMID: 24755151 PMCID: PMC4187516 DOI: 10.1161/jaha.113.000665] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/26/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Virginia Shalkey Hahn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (V.S.H., B.K.)
| | - Daniel J. Lenihan
- Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN (D.J.L.)
| | - Bonnie Ky
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (V.S.H., B.K.)
- Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (B.K.)
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (B.K.)
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111
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Salvo F, Bazin F, Kostrzewa A, Bandre C, Robinson P, Moore N, Bégaud B, Pariente A. Fibrates and Risk of Cancer in Tissues with High PPAR-α Concentration: A Nested Case–Control Study. Drug Saf 2014; 37:361-8. [DOI: 10.1007/s40264-014-0157-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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112
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Liu Y, Qin A, Li T, Qin X, Li S. Effect of statin on risk of gynecologic cancers: a meta-analysis of observational studies and randomized controlled trials. Gynecol Oncol 2014; 133:647-55. [PMID: 24736024 DOI: 10.1016/j.ygyno.2014.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/03/2014] [Accepted: 04/06/2014] [Indexed: 12/19/2022]
Abstract
Objective. Epidemiologic and clinical findings are inconsistent concerning the risk for gynecologic cancers associated with statin use. We conducted a detailed meta-analysis of all relevant original studies to evaluate the effects of statin on the risk of gynecologic cancers. Methods. We searched PubMed, Embase, and Cochrane library databases up to February 2014 looking for eligible studies. Summary relative risk (RR) estimates and 95% confidence intervals (CIs) were used to calculate the risk using random-effects models. Results. A total of 14 (4 randomized controlled trials, 5 cohorts, and 5 case-control) studies, involving 12,904 gynecologic cancer cases, contributed to the analysis. Pooled results indicated a non-significant decrease of total gynecologic cancer risk among statin users (RR=0.89; 95% CI, 0.78-1.01). Stratified analyses across cancer site revealed a modest protective effect of statin on ovarian cancer (RR=0.79; 95% CI, 0.64-0.98), while no association was found for endometrial cancer (RR=0.90; 95% CI, 0.75-1.07). The effect of statin use against cervical cancer and vulvar cancer is not conclusive. Furthermore, long-term statin use (>5years use) did not significantly affect the risk of endometrial cancer (RR=0.69; 95% CI, 0.44-1.10), but had an obvious decrease on the risk of ovarian cancer (RR=0.48; 95% CI, 0.28-0.80). Conclusions. Our results suggest that statin use was inversely associated with ovarian cancer risk, and the association was stronger for long-term statin use (>5years). The evidence for a protective effect of statin use against other gynecologic cancers is suggestive but not conclusive, which deserves further investigation.
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Affiliation(s)
- Yanqiong Liu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Aiping Qin
- Department of Obstetrics and Gynecology and Reproductive center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Taijie Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Qin
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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113
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Chan TF, Wu CH, Lin CL, Yang CY. Statin use and the risk of breast cancer: a population-based case–control study. Expert Opin Drug Saf 2014; 13:287-93. [DOI: 10.1517/14740338.2014.885949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Te-Fu Chan
- Kaohsiung Medical University, Graduate Institute of Medicine, College of Medicine,
Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung Medical University Hospital, Department of Obstetrics and Gynecology,
Kaohsiung, Taiwan
| | - Chen-Hsuan Wu
- Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University, College of Medicine, Department of Obstetrics and Gynecology,
Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Kaohsiung Medical University, College of Medicine, Faculty of Medicine,
Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung Medical University Hospital, Division of Neurosurgery, Department of Surgery,
Kaohsiung, Taiwan
| | - Chun-Yuh Yang
- Kaohsiung Medical University, College of Health Sciences, Department of Public Health,
100 Shih-Chuan 1st RD, Kaohsiung, 80708, Taiwan
- National Health Research Institute, Division of Environmental Health and Occupational Medicine,
Miaoli, Taiwan
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114
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Mandal CC, Rahman MM. Targeting Intracellular Cholesterol is a Novel Therapeutic Strategy for Cancer Treatment. ACTA ACUST UNITED AC 2014; 6:510-513. [PMID: 25821564 PMCID: PMC4376010 DOI: 10.4172/1948-5956.1000316] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Substantial data from cell culture and animal studies evidence the preventive effect of statins, cholesterol lowering-drugs, in regulation of cancer cell proliferation and metastasis. Various clinical studies also support this correlation between use of statin and the reduction of cancer incidence. However, in some cases, statins have failed to decrease the risk of cancer. Since, instead of serum cholesterol, intracellular cholesterol may play a crucial role in the regulation of tumorigenesis and metastasis. The mechanism by which cholesterol is stored within cancer cells may differ among cancer types and also in different individuals. This paper discusses the molecular detail to speculate the statin-sensitive cancer. It also highlights that statins may work better as anticancer therapy if it is used with the combination of a specific microRNA (miR).
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Affiliation(s)
- Chandi C Mandal
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Rajasthan-305817, India
| | - Md Mizanur Rahman
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas-78229, USA
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115
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Pasin L, Landoni G, Castro ML, Cabrini L, Belletti A, Feltracco P, Finco G, Carozzo A, Chiesa R, Zangrillo A. The effect of statins on mortality in septic patients: a meta-analysis of randomized controlled trials. PLoS One 2013; 8:e82775. [PMID: 24391721 PMCID: PMC3876996 DOI: 10.1371/journal.pone.0082775] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/28/2013] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Statins are among the most prescribed drugs worldwide and their recently discovered anti-inflammatory effect seems to have an important role in inhibiting proinflammatory cytokine production, chemokines expression and counteracting the harmful effects of sepsis on the coagulation system. We decided to perform a meta-analysis of all randomized controlled trials ever published on statin therapy in septic patients to evaluate their effect on survival and length of hospital stay. DATA SOURCES AND STUDY SELECTION Articles were assessed by four trained investigators, with divergences resolved by consensus. BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials were searched for pertinent studies. Inclusion criteria were random allocation to treatment and comparison of statins versus any comparator in septic patients. DATA EXTRACTION AND SYNTHESIS Data from 650 patients in 5 randomized controlled studies were analyzed. No difference in mortality between patients receiving statins versus control (44/322 [14%] in the statins group vs 50/328 [15%] in the control arm, RR = 0.90 [95% CI 0.65 to 1.26], p = 0.6) was observed. No differences in hospital stay (p = 0.7) were found. CONCLUSIONS Published data show that statin therapy has no effect on mortality in the overall population of adult septic patients. Scientific evidence on statins role in septic patients is still limited and larger randomized trials should be performed on this topic.
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Affiliation(s)
- Laura Pasin
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
- Maieutics Foundation, Milan, Italy
- * E-mail:
| | | | - Luca Cabrini
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Feltracco
- Department of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | - Gabriele Finco
- Department of Medical Sciences “M. Aresu”, Cagliari University, Cagliari, Italy
| | - Andrea Carozzo
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
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Abstract
Statins are among the most commonly prescribed drugs used to manage dyslipidemia. Hepatocellular carcinoma is the third leading cause of cancer mortality and its rates have recently been increasing in central and northern Europe and USA. To quantify the association between statin use and risk for HCC, we performed a meta-analysis of published studies. We conducted a MEDLINE search for observational studies reporting the association between exposure to statins and risk for incident liver cancer until March 2012. Fixed-effect and random-effect models were used to estimate summary relative risks (RR) and the corresponding 95% confidence intervals (CIs). Moreover, between-study heterogeneity and publication bias were assessed using adequate statistical tests. Five observational studies (two case-control and three cohort studies) based on 2574 cases of HCC were included. Statin treatment, compared with no treatment, was inversely related to HCC (summary RR=0.58; 95% CI 0.46-0.74). Between-study heterogeneity was significant (P<0.001) and numerically relevant (I=65%). When only longest statin use was considered, the RR was 0.66 (95% CI 0.55-0.80). Influence analysis on the overall estimate showed that heterogeneity was largely because of one study; when omitting it, the I dropped to 27% (P=0.240), whereas the summary RR was only marginally modified (RR=0.52; 95% CI 0.44-0.62). There was no evidence of publication bias. This meta-analysis suggests a favorable effect of statins on HCC, in the absence, however, of a duration-risk relationship.
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Künzl M, Wasinger C, Hohenegger M. Statins role in cancer prevention and development-recent meta-analyses. World J Pharmacol 2013; 2:100-106. [DOI: 10.5497/wjp.v2.i4.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/21/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
The therapeutic indications of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) include hypercholesterolaemia and the prevention of cardiovascular events. Statins are well tolerated and beyond their unambiguous positive cardiovascular effects there are a steadily increasing number of pleiotropic actions emerging. In this regard, growth inhibition, apoptosis, anti-inflammatory and immunomodulatory actions have been attributed to statins. The anti-proliferative effects have been the basis for massive preclinical investigations to elucidate a functional role for statins in carcinogenesis and tumor cell growth. However, preclinical and clinical studies are conflicting, although there is accumulating evidence that statins are capable to suppress and decrease the incidence and recurrence of some human cancers. Given the fact that statins are well tolerated they might also have some impact in combinations with conventional and targeted chemotherapy. While synergism has been shown for many combinations in vitro this does not hold true yet in the clinics. Here we review the rational behind usage of statins in oncological settings. Positive effects have been observed in patients with melanoma and cancers from the breast, colon, prostate, lung, liver and hematologic tissues. However, substantial evidence from clinical studies is still weak and confounded by several factors, which are inherent in the study design. The majority of the studies are observational or of retrospective nature. Definitely, there is substantial need for larger, prospective randomized, placebo-controlled trials. Finally, we conclude that statins at the current status of evidence should not be recommended in the prevention or during progression of any cancers, however, individual statins may have beneficial effects in specific tumor subgroups.
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Ioannidis JPA, Zhou Y, Chang CQ, Schully SD, Khoury MJ, Freedman AN. Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses. Ann Oncol 2013; 25:16-23. [PMID: 24310915 DOI: 10.1093/annonc/mdt372] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Several commonly used medications have been associated with increased cancer risk in the literature. Here, we evaluated the strength and consistency of these claims in published meta-analyses. We carried out an umbrella review of 74 meta-analysis articles addressing the association of commonly used medications (antidiabetics, antihyperlipidemics, antihypertensives, antirheumatics, drugs for osteoporosis, and others) with cancer risk where at least one meta-analysis in the medication class included some data from randomized trials. Overall, 51 articles found no statistically significant differences, 13 found some decreased cancer risk, and 11 found some increased risk (one reported both increased and decreased risks). The 11 meta-analyses that found some increased risks reported 16 increased risk estimates, of which 5 pertained to overall cancer and 11 to site-specific cancer. Six of the 16 estimates were derived from randomized trials and 10 from observational data. Estimates of increased risk were strongly inversely correlated with the amount of evidence (number of cancer cases) (Spearman's correlation coefficient = -0.77, P < 0.001). In 4 of the 16 topics, another meta-analysis existed that was larger (n = 2) or included better controlled data (n = 2) and in all 4 cases there was no statistically significantly increased risk of malignancy. No medication or class had substantial and consistent evidence for increased risk of malignancy. However, for most medications we cannot exclude small risks or risks in population subsets. Such risks are unlikely to be possible to document robustly unless very large, collaborative studies with standardized analyses and no selective reporting are carried out.
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Affiliation(s)
- J P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford
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Deng Z, Zhang S, Yi L, Chen S. Can statins reduce risk of lung cancer, especially among elderly people? A meta-analysis. Chin J Cancer Res 2013; 25:679-88. [PMID: 24385695 PMCID: PMC3872546 DOI: 10.3978/j.issn.1000-9604.2013.11.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/06/2013] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE As the most common cause of cancer mortality throughout the world, lung cancer has drawn people's attention on how to reduce the risk with chemopreventive ways. Many epidemiological studies have shown inconsistent effects of statins on lung cancer, but some observational studies have showed that statins had protective effect on lung cancer among elderly people. So we preformed this meta-analysis to find whether statins were chemopreventive. METHODS We searched MEDLINE, EMBASE and Web of Science databases from inception to September, 2013. A total of 23 studies were selected, including 15 observational studies and 8 randomized controlled trials (RCTs). Both fixed and random-effects models were used to calculate pooled estimates in primary and sensitivity analyses. We used Q and I(2) statistics to assess statistical heterogeneity, and evaluated publication bias by Begg's test and Egger's test. RESULTS No association between statins and lung cancer risk was identified either in the meta-analysis among RCTs [relative risk (RR): 0.95, 95% confidence interval (95% CI): 0.85-1.06] or observational studies (RR: 0.89, 95% CI: 0.77-1.04). We also selected 6 observational studies that all researched on elderly people. The result of meta-analysis showed that there was still no protective effect between statins and lung cancer among elderly people (RR: 1.03, 95% CI: 0.96-1.11). CONCLUSIONS Our results did not support a protective effect of statins on the overall lung cancer risk and the lung cancer risk among elderly people. More well-designed RCTs are needed to enhance our understanding of the chemopreventive effect of statins on lung cancer.
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Affiliation(s)
- Zhantao Deng
- Department of Thoracic Surgery, Jiangsu Cancer Hospital Affliated to Nanjing Medicinal University, Nanjing 210009, China
- Key Laboratory of Medical Molecular Technology, Medical School of Nanjing University, Nanjing 210009, China
| | - Shu Zhang
- Nanjing Drum Tower Hospital, Nanjing 210009, China
| | - Long Yi
- Key Laboratory of Medical Molecular Technology, Medical School of Nanjing University, Nanjing 210009, China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital Affliated to Nanjing Medicinal University, Nanjing 210009, China
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Jespersen CG, Nørgaard M, Friis S, Skriver C, Borre M. Statin use and risk of prostate cancer: a Danish population-based case-control study, 1997-2010. Cancer Epidemiol 2013; 38:42-7. [PMID: 24275259 DOI: 10.1016/j.canep.2013.10.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Conflicting evidence has suggested that statins possess chemopreventive properties against prostate cancer (PCa). Therefore, we examined the association between statin use and risk of PCa in a Denmark-based case-control study. MATERIALS AND METHODS We identified 42,480 patients diagnosed with incident PCa during 1997-2010 from a national cancer registry. Five age-matched population controls (n=212,400) were selected for each case using risk-set sampling. Statin use from 1996 to the index date was obtained from the National Prescription Registry. Odds ratios (ORs) adjusted for age, comorbidity, non-steroidal anti-inflammatory drug use, and educational level for PCa associated with statin use, were computed using conditional logistic regression. Analyses were stratified by duration of statin use (0-1, 2-4, 5-9, or ≥10 years), stage of PCa (localized or advanced), and type of statin used (lipophilic or hydrophilic). RESULTS In total, 7915 patients (19%) and 39,384 controls (19%) redeemed statin prescriptions prior to the index date. Overall, statin users had a 6% lower risk of PCa compared with non-users [adjusted OR (ORa), 0.94; 95% confidence interval (CI), 0.91-0.97]. Risk estimates did not differ substantially by duration or type of statin used. Slightly larger statin use-associated risk reductions were observed for advanced PCa (ORa, 0.90; 95% CI, 0.85-0.96) and with statin use ≥10 years (ORa, 0.78; 95% CI, 0.65-0.95). CONCLUSION Statin use was associated with a risk reduction overall (6%) and, specifically with advanced PCa (10%). Differences in diagnostic measures and residual confounding by socioeconomic parameters may have influenced our results.
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Affiliation(s)
- Christina G Jespersen
- Department of Urology, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark; Institute of Clinical Medicine, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Søren Friis
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Charlotte Skriver
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
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A clinical trial of lovastatin for modification of biomarkers associated with breast cancer risk. Breast Cancer Res Treat 2013; 142:389-98. [PMID: 24166281 DOI: 10.1007/s10549-013-2739-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/14/2013] [Indexed: 01/23/2023]
Abstract
Pre-clinical and epidemiologic studies provide rationale for evaluating lipophilic statins for breast cancer prevention. We conducted a single-arm, biomarker modulation trial of lovastatin among women with increased risk of breast cancer. Eligibility criteria included a deleterious germline mutation in BRCA1, BRCA2, CDH1, or TP53; lifetime breast cancer risk of ≥20 % as estimated by the Claus model; or personal history of estrogen receptor and progesterone receptor-negative breast cancer. Participants received 40 mg of lovastatin orally twice daily for 6 months. We evaluated the following biomarkers before and after lovastatin use: breast duct cytology (primary endpoint), serum lipids, C-reactive protein, insulin-like growth factor-1, IGF binding protein-3, lipid peroxidation, oxidative DNA damage, 3-hydroxy-3-methylglutaryl CoA reductase genotype, and mammographic density. Thirty women were enrolled, and 26 (86.7 %) completed the study. For the primary endpoint of changes in breast duct cytology sampled by random periareolar fine needle aspiration, most participants [57.7 %, 95 % confidence interval (CI) 38.9-74.5 %] showed no change after lovastatin; 19.2 % (CI 8.1-38.3 %) had a favorable change in cytology, 7.7 % (95 % CI 1.0-25.3 %) had an unfavorable change, and 15.4 % (95 % CI 5.5-34.2 %) had equivocal results due to acellular specimens, usually after lovastatin. No significant changes were observed in secondary biomarker endpoints. The study was generally well-tolerated: 4 (13.3 %) participants did not complete the study, and one (3.8 %) required a dose reduction. This trial was technically feasible, but demonstrated no significant biomarker modulation; contributing factors may include insufficient sample size, drug dose and/or duration. The results are inconclusive and do not exclude a favorable effect on breast cancer risk.
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Abstract
Cancer risk reduction using pharmacological means is an attractive modern preventive approach that supplements the classical behavioural prevention recommendations. Medications that are commonly used by large populations to treat a variety of common, non-cancer-related, medical situations are an attractive candidate pool. This Review discusses three pharmacological agents with the most evidence for their potential as cancer chemopreventive agents: anti-hypercholesterolaemia medications (statins), an antidiabetic agent (metformin) and antiosteoporosis drugs (bisphosphonates). Data are accumulating to support a significant negative association of certain statins with cancer occurrence or survival in several major tumour sites (mostly gastrointestinal tumours and breast cancer), with an augmented combined effect with aspirin or other non-steroidal anti-inflammatory drugs. Metformin, but not other hypoglycaemic drugs, also seems to have some antitumour growth activity, but the amount of evidence in human studies, mainly in breast cancer, is still limited. Experimental and observational data have identified bisphosphonates as a pharmacological group that could have significant impact on incidence and mortality of more than one subsite of malignancy. At the current level of evidence these potential chemopreventive drugs should be considered in high-risk situations or using the personalized approach of maximizing individual benefits and minimizing the potential for adverse effects with the aid of pharmacogenetic indicators.
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123
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Abstract
Cancer chemoprevention is defined as the pharmacologic intervention, by drugs or nutrient-components, with the process of carcinogenesis, in order to prevent the development of invasive malignant neoplasms. This preventive attempt is particularly challenging in cancer types, which have a long subclinical developmental phase, because of their low cellular proliferation rate and their slow pre-clinical evolution, until they become clinically detectable and therapeutically as well as prognostically relevant. Therefore, only certain specific cancer types are presently in the focus of clinical chemoprevention. Among the GI tract cancer, colorectal (CRC) as well as esophageal cancer have raised the most attention over the past decades, as they both share a long precancerous stage (the adenoma in CRC and Barrett's esophagus in the case of esophageal adenocarcinoma) which provides a window of opportunity to intervene and prevent development of cancer.In this review, we will focus on both CRC as well as esophageal adenocarcinoma (EAC).
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124
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Fendrich V, Sparn M, Lauth M, Knoop R, Plassmeier L, Bartsch DK, Waldmann J. Simvastatin delay progression of pancreatic intraepithelial neoplasia and cancer formation in a genetically engineered mouse model of pancreatic cancer. Pancreatology 2013; 13:502-7. [PMID: 24075515 DOI: 10.1016/j.pan.2013.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Pancreatic cancer is among the most dismal of human malignancies. There are no chemopreventive strategies for pancreatic cancer or its precursor lesions, pancreatic intraepithelial neoplasia (PanINs). Recent evidence suggests that statins have potential chemopreventive abilities. In this study, we used a genetically engineered mouse model of pancreatic cancer to evaluate the chemopreventive potential of this drug. METHODS Simvastatin was injected i.p. in LsL-Kras(G12D); Pdx1-Cre or LsL-Kras(G12D);LsL-Trp53(R172H);Pdx1-Cre mice. After five months, animals were sacrificed. The effect of simvastatin was evaluated by histopathological analyses, immunostaining, and real-time PCR. RESULTS After five months of treatment, simvastatin was able to significantly delay progression of mPanINs in LsL-Kras(G12D); Pdx1-Cre mice. Furthermore, formation of invasive pancreatic cancer in LsL-Kras(G12D); LsL-Trp53(R172H); Pdx1-Cre transgenic mice was partially inhibited by simvastatin. Invasive murine pancreatic cancer was identified in 9 of 12 (75%) LsL-Kras(G12D); LsL-Trp53(R172H);Pdx1-Cre untreated control mice. In contrast, transgenic mice treated with Simvastatin, only 4 out of 10 (40%, p = 0.004) developed murine pancreatic cancer during the study. Using real-time PCR we found a significant up-regulation of Hmgcr as sign of blocking HMG-CoA reductase, a key enzyme in the cholesterol biosynthesis. This shows our ability to achieve effective pharmacologic levels of simvastatin during pancreatic cancer formation in vivo. CONCLUSION Using a transgenic mouse model that recapitulates human pancreatic cancer, this study provides first evidence that simvastatin is an effective chemopreventive agent by delaying the progression of PanINs and partially inhibit the formation of murine pancreatic cancer.
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Affiliation(s)
- Volker Fendrich
- Department of Surgery, Philipps-University Marburg, Baldingerstrasse, D-35043 Marburg, Germany.
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125
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Abstract
In 2010, in France, 8,790 men died from prostate cancer despite a low and decreasing mortality rate. The individual risk/benefit ratio of prostate cancer screening is the focus of controversy and currently not in favor of a systematic screening program. Therefore, only prevention could reduce incidence, side effects of treatment and related mortality. Interestingly, prostate cancer prevention is also a field of controversy mainly about 5-alpha-reductase inhibitors. However, it could be expected that pharmaco- or diet-based prevention will be a huge tool for cancer control, even more for prostate cancer burden. This review comprehensively analyses which molecules or compounds could be used in preventive trials. With regard to pharmaco-prevention, three different kinds of drugs could be identified. First drugs, which aim at mainly or even solely reduce prostate cancer risk such as 5-alpha-reductase inhibitors and selective estrogen receptor modulators. Drugs, which aim at wider preventive impact such as: nonsteroidal anti-inflammatory drugs or difluoromethylornithine. Lastly, drugs for which reducing prostate cancer incidence is merely a side effect such as statins, metformin or histones desacetylase inhibitors. With regard to diet-based prevention, two main approaches could be identified: aliments and nutriments, on one hand, and vitamin and minerals, on the other. Interestingly if compounds reach experimental plausibility, natural foods or even global diet seem to have a higher impact. Lastly, besides assessment of efficacy, effectiveness required the critical step of compliance, which might actually be the weakest link of the prevention chain.
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Affiliation(s)
- Huseyin Naci
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
| | - Jasper Brugts
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
| | - Tony Ades
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
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Teperman L, Moonka D, Sebastian A, Sher L, Marotta P, Marsh C, Koneru B, Goss J, Preston D, Roberts JP. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial. Liver Transpl 2013; 19:675-89. [PMID: 23775875 DOI: 10.1002/lt.23658] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/08/2013] [Indexed: 12/12/2022]
Abstract
Mycophenolate mofetil (MMF) and sirolimus (SRL) have been used for calcineurin inhibitor (CNI) minimization to reduce nephrotoxicity following liver transplantation. In this prospective, open-label, multicenter study, patients undergoing transplantation from July 2005 to June 2007 who were maintained on MMF/CNI were randomized 4 to 12 weeks after transplantation to receive MMF/SRL (n = 148) or continue MMF/CNI (n = 145) and included in the intent-to-treat population. The primary efficacy endpoints were the mean percentage change in the calculated glomerular filtration rate (GFR) and a composite of biopsy-proven acute rejection (BPAR), graft lost, death, and lost to follow-up 12 months after transplantation. Patients were followed for a median of 519 days after randomization. MMF/SRL was associated with a significantly greater renal function improvement from baseline with a mean percentage change in GFR of 19.7 ± 40.6 (versus 1.2 ± 39.9 for MMF/CNI, P = 0.0012). The composite endpoint demonstrated the noninferiority of MMF/SRL versus MMF/CNI (16.4% versus 15.4%, 90% confidence interval = -7.1% to 9.0%). The incidence of BPAR was significantly greater with MMF/SRL (12.2%) versus MMF/CNI (4.1%, P = 0.02). Graft loss (including death) occurred in 3.4% of the MMF/SRL-treated patients and in 8.3% of the MMF/CNI-treated patients (P = 0.04). Malignancy-related deaths were less frequent with MMF/SRL. Adverse events caused withdrawal for 34.2% of the MMF/SRL-treated patients and for 24.1% of the MMF/CNI-treated patients (P = 0.06). The use of MMF/SRL is an option for liver transplant recipients who can benefit from improved renal function but is associated with an increased risk of rejection (but not graft loss).
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Affiliation(s)
- Lewis Teperman
- Mary Lea Johnson Richards Organ Transplant Center, New York University School of Medicine, New York, NY 10016, USA.
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Singh PP, Singh S. Statins are associated with reduced risk of gastric cancer: a systematic review and meta-analysis. Ann Oncol 2013; 24:1721-1730. [PMID: 23599253 DOI: 10.1093/annonc/mdt150] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several observational studies have shown that statins may modify the risk of gastric cancer (GC). We carried out a systematic review and meta-analysis of studies evaluating the effect of statins on GC risk. PATIENTS AND METHODS We conducted a systematic search of multiple databases up to December 2012. Studies that evaluated exposure to statins, reported GC outcomes and odds ratio (OR) or provided data for their estimation were included in the meta-analysis. Pooled OR estimates with 95% confidence intervals (CIs) were calculated using the random-effects model. RESULTS Eleven studies (eight observational, three post-hoc analyses of 26 clinical trials) reporting 5581 cases of GC were included. Meta-analysis showed a significant 32% reduction in GC risk with statin use (adjusted OR, 0.68; 95% CI, 0.51-0.91). After exclusion of one study which was contributing to considerable heterogeneity, a significant 16% reduction in GC risk was a more conservative, consistent estimate (adjusted OR, 0.84; 95% CI, 0.78-0.90). This chemopreventive association was present in both Asian (adjusted OR, 0.68; 95% CI, 0.53-0.87) and Western population (adjusted OR, 0.86; 95% CI, 0.79-0.93). CONCLUSIONS Meta-analysis of studies supports a protective association between statin use and GC risk, in both Asian and Western population, in a dose-dependent manner.
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Affiliation(s)
| | - S Singh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, USA
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129
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Statins are associated with reduced risk of gastric cancer: a meta-analysis. Eur J Clin Pharmacol 2013; 69:1855-60. [PMID: 23748751 DOI: 10.1007/s00228-013-1547-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Statins are widely prescribed to reduce cholesterol levels in the prevention of atherosclerotic cardiovascular disease. However, the debate about the effect of statins on cancer risk remains unsettled. The aim of this study was to investigate the association of utilization of statins with the risk of gastric cancer by carrying out a meta-analysis. METHODS A literature search was performed on PubMed and EMBASE up to March 2013 to identify the cohort or case-control studies or randomized controlled trials (RCTs) that examined the relationship between statins use and the risk of gastric cancer. The bibliographies of the retrieved articles were also reviewed to identify additional studies. A random-effects model was used to calculate the summary relative risks (RRs) with 95 % confidence intervals (CIs). RESULTS Three post-hoc analyses of 26 RCTs involving 290 gastric cancers and eight observational studies totaling 7,321 gastric cancers were included. Statins use was shown to be significantly associated with a 27 % reduction in the risk of gastric cancer (RR = 0.73, 95 % CI = 0.58-0.93), with considerable heterogeneity among studies (I (2) = 88.9 %). Excluding one study in which all subjects are diabetic patients obtained an attenuated, but homogeneous result (RR = 0.85, 95 % CI = 0.80-0.91, I (2) = 0.0 %). These findings were consistent in the subgroup analysis. CONCLUSION A meta-analysis of existing evidence, primarily from observational studies, indicates that use of statins reduces the risk of gastric cancer.
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Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11:620-9. [PMID: 23357487 PMCID: PMC3660516 DOI: 10.1016/j.cgh.2012.12.036] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence of esophageal cancer is increasing in the United States, especially among patients with Barrett's esophagus (BE). Statins might prevent this cancer. We performed a systematic review with a meta-analysis of studies that evaluated the effect of statins on the risk of esophageal cancer. METHODS We conducted a systematic search of Medline, Embase, and Web of Science through August 2012. Studies were included if they evaluated exposure to statins, reported the development of esophageal cancer, and reported relative risks or odds ratios (OR), or provided data for their estimation. Summary OR estimates with 95% confidence intervals (CI) were calculated using the random-effects model. The analysis included 13 studies (including a post hoc analysis of 22 randomized controlled trials) reporting 9285 cases of esophageal cancer among 1,132,969 patients. RESULTS A meta-analysis of the studies showed a significant (28%) reduction in the risk of esophageal cancer among patients who took statins (adjusted OR, 0.72; 95% CI, 0.60-0.86), although there was considerable heterogeneity among studies. In analyzing a subset of patients known to have BE (5 studies, 312 esophageal adenocarcinomas [EAC] developed in 2125 patients), statins were associated with a significant (41%) decrease in the risk of EAC, after adjusting for potential confounders (adjusted OR, 0.59; 95% CI, 0.45-0.78) with consistent results among all studies. The number needed to treat with statins to prevent 1 case of EAC in patients with BE was 389. CONCLUSIONS Based on meta-analysis of observational studies, statin use may be associated with lower risk of esophageal cancer, particularly risk of EAC in patients with BE.
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131
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Tan VPY, Wong BCY. Gastric cancer chemoprevention: the current evidence. Gastroenterol Clin North Am 2013; 42:299-316. [PMID: 23639642 DOI: 10.1016/j.gtc.2013.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chemoprevention may form the cornerstone in the management of gastric adenocarcinoma of the future. Helicobacter pylori eradication and aspirin and/or nonsteroidal anti-inflammatory drug therapy have emerged as front-runner chemotherapeutic agents due to the putative pathogenic mechanisms that they address. Before a population-based chemopreventive strategy can be recommended on a large scale, randomized controlled trials with follow-up of more than 10 years of these 2 agents in populations at high gastric adenocarcinoma risk is urgently awaited.
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Statin use and risk of hepatocellular carcinoma. Eur J Epidemiol 2013; 28:485-92. [PMID: 23681775 DOI: 10.1007/s10654-013-9806-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 04/20/2013] [Indexed: 12/30/2022]
Abstract
The objective of this study was to explore the association between statins use and risk of developing hepatocellular carcinoma (HCC). We used the research database of the Taiwan National Health Insurance program to conduct a population-based case-control study. Cases were 3,480 patients with newly diagnosed HCC identified during 2000 and 2009. Controls were 13,920 subjects without HCC and frequency matched for age, sex and duration of observational period of cases (i.e., the duration between year of being enrolled in the insurance program and index year of cases). Six commercially available statins, including simvastatin, lovastatin, fluvastatin, atorvastatin, pravastatin, and rosuvastatin, were analyzed. The adjusted odds ratio [OR] of HCC was 0.72 [95% (CI) 0.59-0.88] for the group with stains use, when compared to the group with non-use of statins. In sub-analysis, simvastatin (OR 0.69, 95% CI 0.50-0.94), lovastatin (OR 0.52, 95% CI 0.36-0.76) and atorvastatin (OR 0.70, 95% CI 0.53-0.93) were associated with significant reduction in odds of HCC. Statins use correlates with 28% decreased risk of HCC. Individual statins, including simvastatin, lovastatin and atorvastatin, are associated with reduced risk of HCC.
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133
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Falcone D, Gallelli L, Di Virgilio A, Tucci L, Scaramuzzino M, Terracciano R, Pelaia G, Savino R. Effects of simvastatin and rosuvastatin on RAS protein, matrix metalloproteinases and NF-κB in lung cancer and in normal pulmonary tissues. Cell Prolif 2013; 46:172-82. [PMID: 23510472 DOI: 10.1111/cpr.12018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/17/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES In this study, we have evaluated effects of 24-hour treatments with simvastatin or rosuvastatin on RAS protein, NF-κB and MMP expression in LC tissues obtained from 12 patients undergoing thoracic surgery. MATERIALS AND METHODS Normal and lung tumour tissues obtained from each sample were exposed to simvastatin (2.5-30 μm) or rosuvastatin (1.25-30 μm) and western blot analysis was then performed. RESULTS We documented increased expression of proteins, MMP-2, MMP-9 and NF-κB-p65 in LC tissues, with respect to normal tissues (P < 0.01). In the malignant tissues, simvastatin and rosuvastatin significantly (P < 0.01) and dose-dependently reduced RAS protein, MMP-2/9 and NF-κB-p65 expression. CONCLUSIONS In conclusion, our results suggest that simvastatin and rosuvastatin could play a role in LC treatment by modulation of RAS protein, MMP-2/9 and NF-κB-p65.
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Affiliation(s)
- D Falcone
- Department of Health Science, School of Medicine, University of Catanzaro, Catanzaro, Italy
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134
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Tan M, Song X, Zhang G, Peng A, Li X, Li M, Liu Y, Wang C. Statins and the risk of lung cancer: a meta-analysis. PLoS One 2013; 8:e57349. [PMID: 23468972 PMCID: PMC3585354 DOI: 10.1371/journal.pone.0057349] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/21/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Several epidemiologic studies have evaluated the association between statins and lung cancer risk, whereas randomized controlled trials (RCTs) on cardiovascular outcomes provide relevant data as a secondary end point. We conducted a meta-analysis of all relevant studies to examine this association. METHODS A systematic literature search up to March 2012 was performed in PubMed database. Study-specific risk estimates were pooled using a random-effects model. RESULTS Nineteen studies (5 RCTs and 14 observational studies) involving 38,013 lung cancer cases contributed to the analysis. They were grouped on the basis of study design, and separate meta-analyses were conducted. There was no evidence of an association between statin use and risk of lung cancer either among RCTs (relative risk [RR] 0.91, 95% confidence interval [CI] 0.76-1.09), among cohort studies (RR 0.94, 95% CI 0.82-1.07), or among case-control studies (RR 0.82, 95% CI 0.57-1.16). Low evidence of publication bias was found. However, statistically significant heterogeneity was found among cohort studies and among case-control studies. After excluding the studies contributing most to the heterogeneity, summary estimates were essentially unchanged. CONCLUSION The results of our meta-analysis suggest that there is no association between statin use and the risk of lung cancer.
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Affiliation(s)
- Min Tan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Guoliang Zhang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Aimei Peng
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ming Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yang Liu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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135
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Yoon JM, Son KY, Eom CS, Durrance D, Park SM. Pre-existing diabetes mellitus increases the risk of gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19:936-45. [PMID: 23429469 PMCID: PMC3574893 DOI: 10.3748/wjg.v19.i6.936] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/22/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically assess the association between diabetes and incidence of gastric cancer.
METHODS: We searched MedLine (PubMed), EMBASE, and the Cochrane Library without any limitations with respect to publication date or language, we also searched the references of qualifying articles. Case-control studies and cohort studies comparing the risk of gastric cancer between diabetic patients and control subjects were included. We excluded studies reporting only standardized incidence ratios without control groups and those that investigated only mortality but not incidence. Seventeen studies met our criteria, and the qualities of these studies were assessed using the Newcastle-Ottawa Quality Assessment Scale. We performed a meta-analysis of pre-existing diabetes and gastric cancer incidence using the DerSimonian-Laird method for random-effects. For subgroup analyses, we separated the studies by study type, region, sex and method to determine confounding factors and reliability. We also conducted subgroup analyses to examine the effects of smoking, Helicobacter pylori (H. pylori) infection, and cancer site. Publication bias was evaluated using Begg’s test.
RESULTS: A random-effects model meta-analysis showed an increased gastric cancer risk in diabetic patients [relative risk (RR) = 1.19; 95%CI: 1.08-1.31]. Subgroup analyses indicated that this result persisted in cohort studies (RR = 1.20; 95%CI: 1.08-1.34), in studies on populations of both Western (RR = 1.18; 95%CI: 1.03-1.36) and Eastern countries (RR = 1.19; 95%CI: 1.02-1.38), in a female subgroup (RR=1.24; 95%CI: 1.01-1.52), and in highly qualified studies (RR = 1.17; 95%CI: 1.05-1.31). Moreover, these results persisted when the analysis was confined to studies adjusted for well-known gastric cancer risk factors such as smoking (RR = 1.17; 95%CI: 1.01-1.34) and H. pylori infection (RR = 2.35; 95%CI: 1.24-4.46).
CONCLUSION: Pre-existing diabetes mellitus may increase the risk of gastric cancer by approximately 19%. This effect seems to be unrelated to geographical region.
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136
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Lochhead P, Chan AT. Statins and colorectal cancer. Clin Gastroenterol Hepatol 2013; 11:109-18; quiz e13-4. [PMID: 22982096 PMCID: PMC3703461 DOI: 10.1016/j.cgh.2012.08.037] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 08/28/2012] [Indexed: 02/07/2023]
Abstract
The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, more commonly referred to as statins, comprise a family of lipid-lowering drugs that are prescribed on a global scale on account of their proven safety and efficacy in reducing mortality from cardiovascular disease. Beyond their potent pharmacologic inhibition of cholesterol biosynthesis, statins appear to have pleiotropic effects, including modulation of cell growth, apoptosis, and inflammation. Through modulation of these pathways, statins have the potential to influence a wide range of disease processes, including cancer. Much attention has focused on the association between statins and colorectal cancer, raising the prospect that these well-tolerated compounds could form the basis of future chemopreventive strategies. Herein, we review the epidemiologic, clinical, and preclinical data relevant to statins and colorectal neoplasia, and discuss the current status and future potential of statins as chemopreventive agents.
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Affiliation(s)
- Paul Lochhead
- Gastrointestinal Research Group, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
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137
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Singh S, Singh PP, Singh AG, Murad MH, Sanchez W. Statins are associated with a reduced risk of hepatocellular cancer: a systematic review and meta-analysis. Gastroenterology 2013; 144:323-332. [PMID: 23063971 DOI: 10.1053/j.gastro.2012.10.005] [Citation(s) in RCA: 333] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Several studies have shown that statins could have chemopreventive effects on HCC. We performed a systematic review and meta-analysis of studies that evaluated the effects of statins on the risk of HCC. METHODS We conducted a systematic search of MEDLINE, Embase, and Web of Science through May 2012 and manually reviewed the literature. Studies were included if they evaluated and clearly defined exposure to statins, reported the incidence of HCC, and reported relative risks or odds ratios (ORs) or provided data for their estimation. Ten studies reporting 4298 cases of HCC in 1,459,417 patients were analyzed. Summary OR estimates with 95% confidence intervals (CIs) were calculated using the random effects model. Statistical heterogeneity was assessed with the Cochran's Q statistic and I(2) statistic. RESULTS Statin users were less likely to develop HCC than statin nonusers (adjusted OR, 0.63; 95% CI, 0.52-0.76), although the results were heterogeneous (P = .01, I(2) = 59%). This heterogeneity could be accounted for by study location (Asian population [n = 4]: adjusted OR, 0.52; 95% CI, 0.42-0.64; Western population [n = 6]: adjusted OR, 0.67; 95% CI, 0.53-0.85) and design (observational studies [n = 7]: adjusted OR, 0.60; 95% CI, 0.49-0.73; clinical trials [n = 3]: adjusted OR, 0.95; 95% CI, 0.62-1.45). CONCLUSIONS Based on meta-analysis, statin use is associated with a reduced risk of HCC, most strongly in Asian but also in Western populations. Randomized clinical trials in populations at high risk for HCC (especially in Asian populations with hepatitis B) are warranted.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Preet Paul Singh
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Abha Goyal Singh
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
| | - William Sanchez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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138
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Statin use and risk of bladder cancer: a meta-analysis. Cancer Causes Control 2013; 24:769-76. [PMID: 23361339 DOI: 10.1007/s10552-013-0159-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 01/19/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE Emerging evidence suggests that statins may decrease the risk of cancers. However, available evidence on bladder cancer is conflicting. To quantify the association between statin use and risk of bladder cancer, we performed a detailed meta-analysis of published studies regarding this subject. METHODS A literature search was carried out using MEDLINE, EMBASE, and OVID databases between January 1966 and October 2012. Before meta-analysis, between-study heterogeneity and publication bias were assessed using adequate statistical tests. Fixed- and random-effect models were used to estimate summary relative risks (RR) and the corresponding 95 % confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression. Subgroup analyses, sensitivity analysis, and cumulative meta-analysis were also performed. RESULTS A total of 13 (three RCTs, five cohort, and five case-control) studies contributed to the analysis. There was heterogeneity among the studies, but no publication bias. Pooled results indicated a nonsignificant increase in total bladder cancer risk among all statin users [RR = 1.07, 95 % CI (0.95, 1.21)]. Long-term statin use did not significantly affect the risk of total bladder cancer [RR = 1.21, 95 % CI (0.92, 1.59)]. In our subgroup analyses, the results were not substantially affected by study design, region, and confounder adjustment. Furthermore, sensitivity analysis confirmed the stability of the results. CONCLUSIONS The findings of this meta-analysis suggested that there was no association between statin use and risk of bladder cancer. More studies, especially RCTs, are needed to confirm this association.
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139
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Li L, Ying XJ, Sun TT, Yi K, Tian HL, Sun R, Tian JH, Yang KH. Overview of methodological quality of systematic reviews about gastric cancer risk and protective factors. Asian Pac J Cancer Prev 2013; 13:2069-79. [PMID: 22901173 DOI: 10.7314/apjcp.2012.13.5.2069] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A comprehensive overall review of gastric cancer (GC) risk and protective factors is a high priority, so we conducted the present study. METHODS Systematic searches in common medical electronic databases along with reference tracking were conducted to include all kinds of systematic reviews (SRs) about GC risk and protective factors. Two authors independently selected studies, extracted data, and evaluated the methodological qualities and the quality of evidence using R-AMSTAR and GRADE approaches. RESULTS Beta- carotene below 20 mg/day, fruit, vegetables, non-fermented soy-foods, whole-grain, and dairy product were GC protective factors, while beta-carotene 20 mg/day or above, pickled vegetables, fermented soy-foods, processed meat 30 g/d or above, or salty foods, exposure to alcohol or smoking, occupational exposure to Pb, overweight and obesity, helicobacter pylori infection were GC risk factors. So we suggested screening and treating H. pylori infection, limiting the amount of food containing risk factors (processed meat consumption, beta-carotene, pickled vegetables, fermented soy-foods, salty foods, alcohol), stopping smoking, avoiding excessive weight gain, avoidance of Pb, and increasing the quantity of food containing protective components (fresh fruit and vegetables, non-fermented soy-foods, whole-grain, dairy products). CONCLUSIONS The conclusions and recommendations of our study were limited by including SRs with poor methodological bases and low quality of evidence, so that more research applying checklists about assessing the methodological qualities and reporting are needed for the future.
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Affiliation(s)
- Lun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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140
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Rice KR, Koch MO, Cheng L, Masterson TA. Dyslipidemia, statins and prostate cancer. Expert Rev Anticancer Ther 2013; 12:981-90. [PMID: 22845413 DOI: 10.1586/era.12.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Dyslipidemia and prostate cancer are two of the most common medical conditions affecting adult males in the USA. In recent years, a large volume of research has focused on investigating the relationship between these two disease processes as well as the effect of the cholesterol-lowering medications, such as 3-hydroxyl-3-methylglutaryl-coenzyme A reductase inhibitors (better known as 'statins'), on the development and progression of prostate cancer. While there is a paucity of prospective research, encouraging results have been reported in several retrospective clinical studies. Additionally, basic science research has identified interactions between lipids and prostate cancer cells in several key areas. This article will discuss recent clinical and basic science research examining the relationship between dyslipidemia, statins and prostate cancer.
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Affiliation(s)
- Kevin R Rice
- Department of Urology, Indiana University Medical Center, 535 North Barnhill Drive, Indianapolis, IN 46202, USA.
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141
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Sultan S, Hynes N. The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojemd.2013.33025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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142
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Lee J, Lee SH, Hur KY, Woo SY, Kim SW, Kang WK. Statins and the risk of gastric cancer in diabetes patients. BMC Cancer 2012; 12:596. [PMID: 23234464 PMCID: PMC3541242 DOI: 10.1186/1471-2407-12-596] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 12/04/2012] [Indexed: 12/16/2022] Open
Abstract
Background Several studies have suggested a cancer risk reduction in statin users although the evidence remains weak for stomach cancer. The purpose of this study was to use an exact-matching case–control design to examine the risk of gastric cancer associated with the use of statins in a cohort of patients with diabetes. Methods Cases were defined as patients with incident gastric cancer identified by International Classification of Diseases 16.0 ~ 16.9 recorded at Samsung Medical Center database during the period of 1999 to 2008, at least 6 months after the entry date of diabetes code. Each gastric cancer case patient was matched with one control patient from the diabetes patient registry in a 1:1 fashion, blinded to patient outcomes. Results A total of 983 cases with gastric cancer and 983 controls without gastric cancer, matched by age and sex, were included in the analysis. The presence of prescription for any statin was inversely associated with gastric cancer risk in the unadjusted conditional logistic regression model (OR: 0.18; 95% CI: 0.14 – 0.24; P < .0001). Multivariate analysis using conditional logistic regression with Bonferroni’s correction against aspirin indicated a significant reduction in the risk of gastric cancer in diabetes patients with statin prescriptions (OR: 0.21; 95% CI: 0.16 – 0.28; P < .0001). After adjustment for aspirin use, a longer duration of statin use was associated with reduced risk of gastric cancer, with statistical significance (P<.0001). Conclusions A strong inverse association was found between the risk of gastric adenocarcinoma and statin use in diabetic patients.
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Affiliation(s)
- Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul 135-710, Korea
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143
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Lee BH, Taylor MG, Robinet P, Smith JD, Schweitzer J, Sehayek E, Falzarano SM, Magi-Galluzzi C, Klein EA, Ting AH. Dysregulation of cholesterol homeostasis in human prostate cancer through loss of ABCA1. Cancer Res 2012; 73:1211-8. [PMID: 23233737 DOI: 10.1158/0008-5472.can-12-3128] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recent epidemiologic data show that low serum cholesterol level as well as statin use is associated with a decreased risk of developing aggressive or advanced prostate cancer, suggesting a role for cholesterol in aggressive prostate cancer development. Intracellular cholesterol promotes prostate cancer progression as a substrate for de novo androgen synthesis and through regulation of AKT signaling. By conducting next-generation sequencing-based DNA methylome analysis, we have discovered marked hypermethylation at the promoter of the major cellular cholesterol efflux transporter, ABCA1, in LNCaP prostate cancer cells. ABCA1 promoter hypermethylation renders the promoter unresponsive to transactivation and leads to elevated cholesterol levels in LNCaP. ABCA1 promoter hypermethylation is enriched in intermediate- to high-grade prostate cancers and not detectable in benign prostate. Remarkably, ABCA1 downregulation is evident in all prostate cancers examined, and expression levels are inversely correlated with Gleason grade. Our results suggest that cancer-specific ABCA1 hypermethylation and loss of protein expression direct high intracellular cholesterol levels and hence contribute to an environment conducive to tumor progression.
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Affiliation(s)
- Byron H Lee
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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144
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Leung HWC, Chan ALF, Lo D, Leung JH, Chen HL. Common cancer risk and statins: a population-based case-control study in a Chinese population. Expert Opin Drug Saf 2012. [PMID: 23199231 DOI: 10.1517/14740338.2013.744392] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether the use of statins is associated with common cancer risk. METHODS A population-based case-control study was conducted in Taiwan. Cases were defined as all patients who were aged 18 years and older and had received at least two statin prescriptions for use continuously for at least 6 months before a first-time diagnosis of studied cancers between the period of 2000 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by using the Cox proportional hazards model. RESULTS A total of 6841 cases and 27,364 matched controls were analyzed. The adjusted hazard ratio for any statin use and cancer at any site were 0.76 (95% 0.654, 0.891). There were a significant reduced risk of gastric cancer (HR: 0.26, 95% CI: 0.107, 0.588), liver cancer (HR: 0.44, 95% CI: 0.279, 0.723) and uterine cancer (HR: 0.44, 95% CI: 0.279, 0.723) associated with any statins. CONCLUSION Overall, the statins suggested a significant reduced risk of the most common cancers in a large Chinese population, particularly in gastric, liver, and uterine cancers.
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Affiliation(s)
- Henry W C Leung
- Min Sheng General Hospital, Cancer Center, Department of Radiation Therapy, Taipei, 168, Jingguo Road, Taoyuan City, Taoyuan County 330, Taiwan
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145
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CONCLUDING REMARKS. Cancer Biomark 2012. [DOI: 10.1201/b14318-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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146
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Liu W, Brookhart MA, Schneeweiss S, Mi X, Setoguchi S. Implications of M bias in epidemiologic studies: a simulation study. Am J Epidemiol 2012; 176:938-48. [PMID: 23100247 DOI: 10.1093/aje/kws165] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Collider-stratification bias arises from conditioning on a variable (collider) which opens a path from exposure to outcome. M bias occurs when the collider-stratification bias is transmitted through ancestors of exposure and outcome. Previous theoretical work, but not empirical data, has demonstrated that M bias is smaller than confounding bias. The authors simulated data for large cohort studies with binary exposure, an outcome, a collider, and 2 predictors of the collider. They created 178 scenarios by changing the frequencies of variables and/or the magnitudes of associations among the variables. They calculated the effect estimate, percentage bias, and mean squared error. M bias in these realistic scenarios ranged from -2% to -5%. When the authors increased one or both relative risks for the relation between the collider and unmeasured factors to ≥8, the negative bias was more substantial (>15%). The result was substantially biased (e.g., >20%) if an unmeasured confounder that was also a collider was not adjusted to avoid M bias. In scenarios resembling those the authors examined, M bias had a small impact unless associations between the collider and unmeasured confounders were very large (relative risk > 8). When a collider is itself an important confounder, controlling for confounding would take precedence over avoiding M bias.
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Affiliation(s)
- Wei Liu
- Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA.
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147
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Bansal D, Undela K, D'Cruz S, Schifano F. Statin use and risk of prostate cancer: a meta-analysis of observational studies. PLoS One 2012; 7:e46691. [PMID: 23049713 PMCID: PMC3462187 DOI: 10.1371/journal.pone.0046691] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/04/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Emerging evidence suggests that statins may decrease the risk of cancers. However, available evidence on prostate cancer (PCa) is conflicting. We therefore examined the association between statin use and risk of PCa by conducting a detailed meta-analysis of all observational studies published regarding this subject. METHODS Literature search in PubMed database was undertaken through February 2012 looking for observational studies evaluating the association between statin use and risk of PCa. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model (DerSimonian and Laird method). Subgroup analyses, sensitivity analysis and cumulative meta-analysis were also performed. RESULTS A total of 27 (15 cohort and 12 case-control) studies contributed to the analysis. There was heterogeneity among the studies but no publication bias. Statin use significantly reduced the risk of both total PCa by 7% (RR 0.93, 95% CI 0.87-0.99, p = 0.03) and clinically important advanced PCa by 20% (RR 0.80, 95% CI 0.70-0.90, p<0.001). Long-term statin use did not significantly affect the risk of total PCa (RR 0.94, 95% CI 0.84-1.05, p = 0.31). Stratification by study design did not substantially influence the RR. Furthermore, sensitivity analysis confirmed the stability of results. Cumulative meta-analysis showed a change in trend of reporting risk from positive to negative in statin users between 1993 and 2011. CONCLUSIONS Our meta-analysis provides evidence supporting the hypothesis that statins reduce the risk of both total PCa and clinically important advanced PCa. Further research is needed to confirm these findings and to identify the underlying biological mechanisms.
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Affiliation(s)
- Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar, Mohali, Punjab, India.
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148
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Sahi H, Koljonen V, Böhling T, Neuvonen PJ, Vainio H, Lamminpää A, Kyyrönen P, Pukkala E. Increased incidence of Merkel cell carcinoma among younger statin users. Cancer Epidemiol 2012; 36:421-4. [DOI: 10.1016/j.canep.2012.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/12/2012] [Accepted: 05/15/2012] [Indexed: 12/20/2022]
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149
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Sultan S, Hynes N. Cardiovascular disease: primary prevention, disease modulation and regenerative therapy. Vascular 2012; 20:243-50. [PMID: 23019607 DOI: 10.1258/vasc.2012.ra0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular primary prevention and regeneration programs are the contemporary frontiers in functional metabolic vascular medicine. This novel science perspective harnesses our inherent ability to modulate the interface between specialized gene receptors and bioavailable nutrients in what is labeled as the nutrient-gene interaction. By mimicking a natural process through the conveyance of highly absorbable receptor specific nutrients, it is feasible to accelerate cell repair and optimize mitochondrial function, thereby achieving cardiovascular cure. We performed a comprehensive review of PubMed, EMBASE and Cochrane Review databases for articles relating to cardiovascular regenerative medicine, nutrigenomics and primary prevention, with the aim of harmonizing their roles within contemporary clinical practice. We searched in particular for large-scale randomized controlled trials on contemporary cardiovascular pharmacotherapies and their specific adverse effects on metabolic pathways which feature prominently in cardiovascular regenerative programs, such as nitric oxide and glucose metabolism. Scientific research on 'cardiovascular-free' centenarians delineated that low sugar and low insulin are consistent findings. As we age, our insulin level increases. Those who can decelerate the rapidity of this process are prompting their cardiovascular rejuvenation. It is beginning to dawn on some clinicians that contemporary treatments are not only failing to impact on our most prevalent diseases, but they may be causing more damage than good. Primary prevention programs are crucial elements for a better outcome. Cardiovascular primary prevention and regeneration programs have enhanced clinical efficacy and quality of life and complement our conventional endovascular practice.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Ireland.
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Kuo CC, Chiu HF, Lee IM, Kuo HW, Lee CT, Yang CY. Statin use and the risk of bladder cancer: a population-based case–control study. Expert Opin Drug Saf 2012; 11:733-8. [DOI: 10.1517/14740338.2012.712960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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