Abstract
Background: Patients with heart failure (HF) have an increased risk of incident cancer. Data relating to the association of statin use among patients with HF on cancer risk and cancer-related mortality are sparse. Methods: Using a previously validated territory-wide clinical information registry, statin use was ascertained among all eligible patients with HF (N=87102) from 2003 to 2015. Inverse probability of treatment weighting was used to balance baseline covariates between statin nonusers (50926 patients) with statin users (36176 patients). Competing risk regression with Cox proportional-hazard models was performed to estimate the risk of cancer and cancer-related mortality associated with statin use. Findings: Of all eligible subjects, the mean age was 76.5±12.8 years, 47.8% was male. Over a median follow-up of 4.1 years (interquartile range [IQR]: 1.6 to 6.8), 11052 (12.7%) were diagnosed with cancer. Statin use (vs. none) was associated with a 16% lower risk of cancer incidence (multivariable adjusted subdistribution hazard ratio [SHR]=0.84; 95% Confidence Interval [CI], 0.80 to 0.89). This inverse association with risk of cancer was duration-dependent; as compared with short-term statin use (3 months to <2 years), the adjusted SHR were 0.99 (95% CI, 0.87 to 1.13) for 2 to < 4 years of use, 0.82 (95% CI, 0.70 to 0.97) for 4 to < 6 years of use, and 0.78 (95% CI, 0.65 to 0.93) for ≥6 years of use. Ten-year cancer-related mortality was 3.8% among statin users and 5.2% among nonusers (absolute risk difference, −1.4 percentage points [95% CI, −1.6% to −1.2%]; adjusted SHR=0.74; 95% CI, 0.67 to 0.81). Interpretation: Our study suggests that statin use is associated with a significantly lower risk of incident cancer and cancer-related mortality in HF, an association that appears to be duration-dependent. Funding Statement: No funding sources. Declaration of Interests: There is no conflict of interest. Ethics Approval Statement: The study was approved by the institutional review board of the University of Hong Kong and the West Cluster of the Hong Kong Hospital Authority.
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