Effect of Statins on Survival Following Stroke in Patients With Cancer

Association between statin use and second cancer risk in breast cancer patients: a nationwide population-based cohort study

PURPOSE

Many studies have revealed that statin therapy reduced mortality in cancer patients, especially in breast cancer, but the effect for second cancer was unclear. We, therefore, performed a comparable cohort study to determine the risk of second cancer in breast cancer patients with statin therapy.

METHODS

Using claims data from Taiwan's National Health Insurance Program, this study enrolled newly diagnosed breast cancer patients from 2000 to 2007 with and without statin therapy as the statin (n = 1222) and nonstatin (n = 4888) cohorts, respectively. The nonstatin cohort was propensity score matched by cohort entry year, age, and randomly selected comorbidities. These two cohorts were followed up until the diagnosis of second cancer, death, or the end of 2011. Cox proportional hazard models were used to estimate the hazard ratios.

RESULTS

The statin cohort had a lower incidence rate than the nonstatin cohort for second cancer (7.37 vs. 8.36 per 1000 person-years), although the difference was not significant (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.65-1.26). Compared with the nonstatin cohort, the second cancer risk was significantly higher for patients taking pravastatin (aHR 2.71, 95% CI 1.19-6.19) but lower for those receiving multiple statin treatment (aHR 0.45, 95% CI 0.25-0.81) and combined lipophilic and hydrophilic type of statin (aHR 0.42, 95% CI 0.20-0.89). The risk was lower for patients receiving a cumulative defined daily dose (cDDD) of > 430 (aHR 0.41, 95% CI 0.19-0.86).

CONCLUSION

This study showed that there is little association between statin use and second cancer risk in breast cancer patients.

Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis

Background: Statins lower the risk of recurrent stroke and mortality and improve outcomes in patients with ischemic stroke. However, the effects of statins on atrial fibrillation (AF)-related stroke are not well-established. Our study aims to investigate the effects of statin therapy on the clinical outcomes in patients with AF-related stroke.

Methods: Electronic databases (MEDLINE, Embase, and Scopus) were searched for previous studies on the effects of pre- and post-stroke statins on the clinical outcomes in AF-related stroke patients. The primary outcome was all-cause mortality. Secondary outcomes included recurrent ischemic stroke, acute coronary events, major adverse cardiovascular events (MACE), and short-term functional outcomes. We extracted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (CI) from each study and pooled them through a meta-analysis.

Results: A total of eight studies (five on post-stroke statins and three on pre-stroke statins) with 12,216 patients were included in the analysis. Post-stroke statin therapy reduced the risk of all-cause mortality (HR, 0.63; 95% CI, 0.55–0.74). This beneficial effect was sustained regardless of statin intensity. However, no significant associations were observed between statin therapy and a reduction in the risk of recurrent ischemic stroke, acute coronary events, or MACE. Pre-stroke statin use was associated with a lower risk of poor short-term functional outcomes (OR, 0.63; 95% CI, 0.47–0.85).

Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.