The relationship between statins and breast cancer prognosis varies by statin type and exposure time: A meta-analysis.

Abstract

e21606 Background:Breast cancer is the most common cancer in females. The effects of statins on breast cancer prognosis have long been controversial, so it is important to investigate the relationship between statin type, exposure time, and breast cancer prognosis. This study sought to explore the effect of statins on breast cancer prognosis. Methods:We searched the MEDLINE, EMBASE, Cochrane Library between October 15, 2016 and January 20, 2017. Searches combined the terms “breast neoplasms[MeSH]”, “statins”, “prognosis” or “survival” or “mortality” with no limit on publication date. Data were analyzed using Stata/SE 11.0. Results: 7 studies finally met the selection criteria and 197,048 included women. Overall statin use was associated with lower cancer-specific mortality and all-cause mortality (HR 0.73, 95% CI 0.59-0.92, P = 0.000 and HR 0.72, 95% CI 0.58-0.89, P = 0.000). Lipophilic statins were associated with decreased breast cancer-specific and all-cause mortality (HR 0.57, 95% CI 0.46-0.70, P = 0.000 and HR 0.57, 95% CI 0.48-0.69, P = 0.000); however, hydrophilic statins were weakly protective against only all-cause mortality (HR 0.79, 95% CI 0.65-0.97, P = 0.132) and not breast cancer-specific mortality (HR 0.94, 95% CI 0.76-1.17, P = 0.174). Of note, more than four years of follow-up did not show a significant correlation between statin use and cancer-specific mortality or all-cause mortality (HR 0.84, 95% CI 0.71-1.00, P = 0.616 and HR 0.95, 95% CI 0.75-1.19, P = 0.181), while groups with less than four years of follow-up still showed the protective effect of statins against cancer-specific mortality and all-cause mortality (HR 0.62, 95% CI 0.44-0.87, P = 0.000 and HR 0.61, 95% CI 0.45-0.80, P = 0.000). Conclusions:Although statins can reduce breast cancer patient mortality, the benefit appears to be constrained by statin type and follow-up time. Lipophilic statins showed a strong protective function in breast cancer patients, while hydrophilic statins only slightly improved all-cause mortality. Finally, the protective effect of statins could only be observed in groups with less than four years of follow-up.

Statins: a role in breast cancer therapy?

“…A systematic review and meta‐analysis reported a summary relative risk associating statin use with breast cancer recurrence of 0.64 (95% CI: (0.53–0.79) . Another meta‐analysis showed that statin use was associated with lower breast cancer‐specific mortality (lipophilic statins) and all‐cause mortality (lipophilic and hydrophilic statins) . A third meta‐analysis of observational studies showed that postdiagnostic statin use was associated with lower cancer‐specific mortality in breast cancer, and prediagnostic statin use was negatively associated with both all‐cause and cancer‐specific mortality .…”

Lovastatin‐mediated MCF‐7 cancer cell death involves LKB1‐AMPK‐p38MAPK‐p53‐survivin signalling cascade

“…Recent studies demonstrated that stains usage reduces breast cancer-specific mortality in patients with breast cancer. 33,34 Kotamraju et al 35 reported that statins activate arginase-dependent pathways to cause cell death in breast cancer cells. Induction of oxidative stress, 36 stimulation of inducible nitric oxide synthase (iNOS) 35 or alterations of Bax and Bcl-2 levels 37 has been explored as a possible cause of statins' cytotoxicity in MCF-7 breast cancer cells.…”

Reduced risk of post ERCP pancreatitis in statin users

“…For inpatients, statin administration was documented in the charts within 24 h. Statins cause both acute and chronic changes in metabolism, inflammatory state, and vascular morphology. Studies have shown that many effects of statins last more than 2 days after discontinuation, however, some acute effects of statins may be mitigated by missing a dose [24]. This may introduce some bias, however, any effect introduced by 'wearing away' of some therapeutic effect of statins should drive the results towards null hypothesis, and therefore it should not affect the conclusions derived from this study.…”