Review of the risks of cancer and cognitive dysfunction associated with statins

1. Statins & cancer risk

3. Methods:
• A retrospective cohort analysis of cancer incidence in older
adults who have and who have not used statins was
performed in11 million analyzable patient records from
January 1990 through February 2009 drawn from the General
Electric Centricity electronic medical records database
Results:
• After matching, the incidence of cancer in patients taking a
statin was 11.37% compared with 11.11% in matched patients
not taking a statin
Conclusion:
• There is no statistically significant increased risk of cancer
associated with statins

4. Cai H, Zhang G, Wang Z, Luo Z, Zhou X (2015) Relationship Between the Use of Statins and Patient
Survival in Colorectal Cancer: A Systematic Review and Meta-Analysis. PLoS ONE 10(6): e0126944

5. • PubMed and Embase databases for relevant
studies published up to September 2014 that
assessed statin use and CRC prognosis
• The primary outcomes were overall survival
(OS) and cancer-specific survival (CSS).

6. Results
30% reduction in
CRC-specific
mortality
24% reduction in
overall mortality

7. • Retrospective observational study
• 22,000 high-risk prostate cancer patients who were
receiving statin or metformin or both
(CSM=combination statin metformin)
• Stratification done based on presence or absence of
obesity/metabolic syndrome
• Aim: To examine the association between treatment
with CSM and prostate cancer specific mortality (PCSM)
by obesity/MetS status
American Society of Clinical Oncology (ASCO) 2015 Annual Meeting: Abstracts 1506 and 5018. Presented May 30, 2015.

8. Results
43% reduction in
cancer risk with
combined use
Even when statins
are used alone,
there is 40%
reduction in risk

9. Conclusion
Both statin use alone and in combination
with metformin are associated with a
reduction in prostate cancer specific
mortality

10. American Society of Clinical Oncology (ASCO) 2015 Annual Meeting: Abstracts 1506 and 5018. Presented May 30, 2015.

11. • Aim: To investigate the association between statin use and all-
cancer mortality in a prospective cohort of postmenopausal
women
• Data taken from Women’s Health Initiative Observational
Study
• Subjects were 1,46,326 postmenopausal women aged 50 to
79 years who were enrolled between 1993 and 1998
• Association between patients' never having used statins,
current statin use, and past statin use, as well as the incidence
and number of deaths from cancer was determined over a
mean follow-up period of 14 years
• Confounding factors, including age, race/ethnicity, education,
smoking, physical activity, family history of cancer were
accounted for

12. 23%
43%
40%
Overall cancer
mortality
Breast
cancer
Colorectal
cancer
Results
Current statin use was associated with risk
reduction in :
42%
Ovarian
cancer

13. Conclusion:
In a cohort of postmenopausal women, regular
use of statins or other lipid-lowering medications
may decrease cancer mortality, regardless of the
type, duration, or potency of statin medications
used

15. • Historically, there has
always been a concern
that statins affect
cognition
• In February 2012, FDA
changes in labeling for
statins about reversible
changes such as ill-
defined memory loss and
confusion which was
applicable to all statins
Swiger KJ. Mayo Clin Proc. 2013 Nov;88(11):1213-21

16. • Like other non-cardiovascular effects, statin-induced
cognitive dysfunction has a mixed body of evidence
• While some past studies have shown negative effect
on cognition, they have been controversial and are of
low methodological quality
• Since then, however, evidence has mounted in
support of statins having a protective effect against
dementia
• This has been attributed to the inhibition of
mevalonate production in the CNS by statins
Shah NP et al. Curr Atheroscler Rep. 2015 Jan;17(1):466

17. Data from meta-analysis-1

18. Data from meta-analysis-2

19. Recommendations for practice
• According to FDA data, adverse event reporting rates
for dementia are similar among statins, losartan and
clopidogrel
• At present, patients and physicians can be reassured
about concerns related to neurocognitive effects of
statin therapy, and the evidence does not support a
change to practice guidelines
Richardson K et al. Ann Intern Med. 2013 Nov 19;159(10):688-97
Swiger KJ. Mayo Clin Proc. 2013 Nov;88(11):1213-21