1. Researchers examined the association between statin use and cancer-related mortality using Danish national registries containing data on cancer diagnoses, prescriptions, and deaths from 1995-2007. 2. They found that cancer patients who used statins had a 15% lower risk of death from cancer compared to non-users. 3. The potential benefits were highest for colon, liver, esophageal, and prostate cancers. However, the study had limitations such as lacking treatment data for most patients and being limited to Denmark. Further research is still needed.

1. SF Nielsen, BG Nodrsetgaard, and SE Bojesen
A Review of New England Journal Of Medicine
Article 2012: 237: 1792-1802
Presented by: Mario Wilmath

2. • Discuss disease state
• Convey study purpose
• Review study design and population
• Evaluate study results
• Discuss conclusions
• Discuss strength, limitations, clinical value

3. • Previous meta-analysis suggested a relationship
between statin use and decreased progression of
colon, esophageal, and prostate CA
• Denmark possesses a unified, complete database
encompassing Cancer Registry, Death Registry,
Prescriptions, and Comprehensive History
• Statins are commonly prescribed and generically
available

4. • “A reduction in the availability of cholesterol may
limit the cellular proliferation required for CA
growth & metastasis. We tested the hypothesis
that statin use begun before a CA diagnosis is
associated with reduced CA-related mortality.”

6. www.cancerresearchuk.org/cancer.../cancerstats/mortality/cancerdeat... www.conferenceboard.ca › ... › Details and Analysis › Health

7. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and
Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention and National Cancer Institute; 2012. Available
at:www.cdc.gov/uscs.

8. 20. Perinatal Period Conditions 10. Chronic Liver Disease
19. Aortic Aneurysm & Dissection 9. Suicide
18. Pneumonitis 8. Nephritis
17. HIV 7. Alzheimer's
16. Homicide 6. DM2
15. Benign tumor 5. CVA
14. Parkinson's Disease 4. Unintentional Injury
13. Hypertension 3. Chronic Lower Respiratory Disease
12. Septicemia 2. CANCER
11. Influenza & Pneumonia 1. Heart Disease
Thompson-Reuters 2012

9. • Primary: Determine extent of association
between statin users and decreased cancer-
related mortality
• Secondary: Determine dose relationship of statin
use to mortality
• Safety: None
• Other: Generate further hypotheses

10. Retrospective cohort analysis with further 1:3
nesting of subgroups
Cohorts divided into statin users vs. non-statin users

11. • INCLUSION
– 40 years of age
– Diagnosis of cancer
– Diagnosis occurred between 1995-2007
• EXCLUSION:
<40 years of age

13. • Statistics Denmark conducted analysis
• Blinding of cancer diagnosis to statin use
• Blinding of statin use to cancer diagnosis
• Calculations performed using Strata Software,
version 12.0MP

14. • Any statin use within 6 months of diagnosis
• Nesting with age, sex, cancer matching due to
changes in statin use over timeframe
• Subgroups of cardiovascular and diabetes
• Subgroups of statin dose, total of 4 strata
• Cumulative Incidence Curves
• Multivariate Cox Regression model analysis

16. Hazard ratios for statin users:
• 0.85 (95% CI, 0.83 to 0.87) for death from any cause
• 0.85 (95% CI, 0.82 to 0.87) for death from CA
Adjusted hazard ratios for death from any cause according to
the defined daily statin dose:
• 0.82 (95% CI, 0.81 to 0.85) for a dose of 0.01 to 0.75 defined daily dose per day
• 0.87 (95% CI, 0.83 to 0.89) for 0.76 to 1.50 defined daily dose per day
• 0.87 (95% CI, 0.81 to 0.91) for higher than 1.50 defined daily dose per day
Adjusted hazard ratios for death from cancer according to the
defined daily statin dose: :
• 0.83 (95% CI, 0.81 to 0.86)
• 0.87 (95% CI, 0.83 to 0.91)
• 0.87 (95% CI, 0.81 to 0.92)
Reduced mortality among statin users observed for 13 CA types

17. • Cumulative incidence of death from cancer, as a
function of follow-up time, significantly lower in statin
users than those who had never used statins (log-rankP<0.001).
• Multivariable hazard ratio 0.85 (95% confidence interval from 0.82 to 0.87).
• Cumulative incidence of death from any cause lower
( log-rank P<0.001).
• Multivariable hazard ratio 0.85 (95% confidence interval from 0.83 to 0.87).
• Outcomes similar regardless of statin dose given.

19. • Some studies suggest cancer cells need cholesterol
• Lack of cholesterol shown to inhibit tumor growth
• Did not address if statins can prevent cancer
• Lower dose had higher survival than higher doses
• Dose trend absence indicates some statin effect

20. When researchers examined deaths from all CAs,
they found that pts w/ a history of statin use had
a 15% lower risk of dying than those who had not
used drugs

21. • Missing info about treatment, tumor size, & spread
• Higher likelihood statin users had heart disease &
might have also been targeted for smoking cessation
• Chemo/radiation data missing for 72 % statin group
• Homogeneous Danish population, not generalizable
• Increased health awareness possible with statin use

22. 1.Basic research into plausible cause and effect
2.Need to examine existing research to determine
agent, dose, & duration of follow-up for a more
powerful & convincing study
3.Population studies needed to extend the results
beyond Denmark

23. Researchers did not report any external support

24. 1. Statin use is associated with reduced CA-related mortality.
2. This is only a preliminary, observational study.
3. Cancer patients from 1995-2007 did not include newer agents.
4. The potential benefits of statin therapy have highest
correlation to colon, liver, esophageal, & prostate cancer.
5. Chemopreventive benefits of statins even greater among
patients using ASA or NSAIDs in other meta-analyses.
6. Cancer prevention and treatment involves a inter-disciplinary
approach to include diet, risk factor modification, medicinal,
socio-cultural preference, and education.

25. 1. American CA Society American Institute for CA Research Medical News Today
2. Caporaso NE "Statins & CA-related mortality -- let's work together" N Engl J Med 2012; 367:
1848-1850.
3. Michaud, D.New England Journal of Medicine, May 6, 1999.Ohio State U.Exten
4. Nielsen SF, et al "Statin use & reduced CA-related mortality" N Engl J Med 2012; 367: 1792-
1802.
5. Charles Bankhead. “Statins May Cut Esophageal Cancer Risk.” MedPage Today Published:
October 22, 2012
6. Algara A., Rothwell PM. “Effects of regular aspirin on long-term cancer incidence and
metastasis: A systematic comparison of evidence from observational studies versus
randomised trials.” The Lancet Oncology, Volume 13, Issue 5, Pages 518 - 527, May 2012.
doi:10.1016/S1470-2045(12)70112-2 Published Online: 21 March 2012
7. PM Rothwell, et al. Effect of daily aspirin on long-term risk of death due to cancer: Analysis of
individual patient data from randomised trials. The Lancet, Volume 377, Issue 9759, Pages 31 -
41, 1 January 2011. doi:10.1016/S0140-6736(10)62110-1
8. Pradelli D, et al. Statins and primary liver cancer: A meta-analysis of observational studies.
European Journal of CA Prevention. 2012 June 28; doi: 10.1097CEJ06013e.
9. United States Cancer Statistics: 2008 Incidence and Mortality report (USCS). Centers for Disease
Control and Prevention Division of CA Prevention and Control. Accessed November 2012.

26. http://www.gatorzone.com/