Abstract
Concerns about the hazards of statins on the development and mortality of stomach cancers remain controversial. Here, we investigated the likelihood of incident gastric cancers and related mortality depending on statin exposure, statin type, and the duration of use. This nested case–control-designed study was composed of 8798 patients who were diagnosed with gastric cancer and matched with 35,192 controls at a 1:4 ratio based on propensity scores of age, sex, residential area, and income from the Korean National Health Insurance Service—Health Screening Cohort database (2002–2015). Propensity score overlap weighting was adjusted to balance the baseline covariates. Overlap propensity score-weighted logistic regression analyses were assessed to determine associations of the prior use of statins (any statin, hydrophilic statins vs. lipophilic statins) with incident gastric cancer and its mortality depending on the medication duration (<180 days, 180–545 days, and >545 days) after adjusting for multiple covariates. After adjustment, the use of any statin, hydrophilic statins, or lipophilic statins showed significant associations with lower odds for incident stomach cancer when used for a short-term period (180–545 days) (OR = 0.88, 95% CI = 0.81–0.86, p = 0.002; OR = 0.78, 95% CI = 0.66–0.92, p = 0.004; and OR = 0.91, 95% CI = 0.84–0.99, p = 0.039, respectively) compared to the control group. Hydrophilic statin use for 180–545 days was associated with 53% lower overall mortality (OR = 0.47; 95% CI = 0.29–0.77). In subgroup analyses, beneficial effects on both cancer development and mortality persisted in patients ≥65 years old, patients with normal blood pressure, and patients with high fasting glucose levels. There were no such associations with long-term statin use (>545 days). Thus, the current nationwide cohort study suggests that prior short-term statin use may have anti-gastric cancer benefits in elderly patients with hyperglycemia.
Highlights
Stomach cancers are the fifth major cause of both cancer and cancer-related death inKorea, one of the geographical regions with the highest risk for gastric cancer worldwide [1].The important risk factors for gastric cancer include advanced age, male sex, family history, Helicobacter pylori, history of chronic atrophic gastritis or pernicious anemia, obesity, chemical carcinogen use, smoking, red meat, alcohol consumption, and low socioeconomic status [2]
This study extended previous studies in the field; we further investigated potential risk factors related to statin use that may be predictive of incident gastric cancer and its mortality according to statin type and duration of use
In this large nationwide cohort study, we demonstrated that prior short-term statin use reduced the likelihood of gastric cancer and its overall mortality regardless of statin type
Summary
Stomach cancers are the fifth major cause of both cancer and cancer-related death inKorea, one of the geographical regions with the highest risk for gastric cancer worldwide [1].The important risk factors for gastric cancer include advanced age, male sex, family history, Helicobacter pylori, history of chronic atrophic gastritis or pernicious anemia, obesity, chemical carcinogen use, smoking, red meat, alcohol consumption, and low socioeconomic status [2]. There are two nationwide epidemiological studies regarding the influence of prior statin use on the development of stomach cancers based on Korean individuals [16,24]. These studies did not investigate the relationships of the duration of statin use or statin types with the incidence and mortality of gastric cancer, and whether prior statin use affects the risk or mortality of gastric cancer according to the statin types and duration of use remains debated. One Dutch study dealing with pharmacy databases and other metaanalyses conducted in Japan denied that gastric cancer risk is affected by statin use [25,26]
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