Abstract
BackgroundPatients living with chronic obstructive pulmonary disease (COPD) are at an increased risk of lung cancer. A common comorbidity of COPD is cardiovascular disease; as such, COPD patients often receive statins. This study sought to understand the association between statin exposure and lung cancer risk in a population-based cohort of COPD patients.MethodsWe identified a population-based cohort of COPD patients based on having filled at least three prescriptions for an anticholinergic or short-acting beta-agonist (SABA). We used an array of methods of defining medication exposure including three conventional methods (ever statin exposure, cumulative duration of use, and cumulative dose) and two novel methods (recency-weighted cumulative duration of use and recency-weighted cumulative dose). To assess residual confounding, a negative control exposure was used to test the validity of our results. All exposure variables were time-dependent.ResultsThe population-based cohort of COPD had 39,879 patients with mean age of 70.6 (SD: 11.2) years and, of which, 53.5% were female. There were 12,469 patients who received at least one statin prescription. Results from the reference case multivariable analysis indicated a reduced risk from statin exposure (HR: 0.85 (95% CI: 0.73–1.00) in COPD patients, but this result not statistically significant. Using the two recency-weighted modelling approaches, statin exposure was associated with a statistically significant reduction in lung cancer risk (recency-weighted cumulative dose, HR: 0.85 (95% CI: 0.77–0.93) and recency-weighted cumulative duration of use, HR: 0.97 (95% CI: 0.96–0.99). Multivariable analysis incorporating the negative control exposure was not statistically significant (HR: 0.89 (95% CI: 0.75–1.10).ConclusionsThe results of this population-based analysis indicate that statin use in COPD patients may reduce the risk of lung cancer. While the effect was not statistically significantly across all exposure definitions, the overall results support the hypothesis that COPD patients might benefit from statin therapy.
Highlights
Chronic obstructive pulmonary disease (COPD) is associated with considerable morbidity and mortality [1]
Lung cancer histology Of the 994 cases of lung cancer identified within the chronic obstructive pulmonary disease (COPD) cohort, 854 were classified as non-small cell lung cancer (NSCLC) and 117 were classified as small cell lung cancer (SCLC)
This study evaluated the association between lung cancer risk and statin exposure in a population-based cohort of COPD patients using an array of metrics for quantifying medication exposure
Summary
Chronic obstructive pulmonary disease (COPD) is associated with considerable morbidity and mortality [1]. Multiple factors may increase COPD patients’ lung cancer risk, one of which is that COPD patients typically have a history of smoking [11]. It would appear that in a subset of patients, the increased risk of lung cancer extends beyond what can be attributed to their smoking status or history. In these patients, the additional risk of lung cancer may be due to increased lung and/or systemic inflammation that can increase their risk of cancer. Patients living with chronic obstructive pulmonary disease (COPD) are at an increased risk of lung cancer. This study sought to understand the association between statin exposure and lung cancer risk in a population-based cohort of COPD patients
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