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A Meta-analysis

Krista M. Dale, PharmD; Craig I. Coleman, PharmD; Nickole N. Henyan, PharmD; Jeffrey Kluger, MD; C. Michael White, PharmD

JAMA. 2006;295:74-80.

Context  Statins are cholesterol-lowering drugs that have been proven in randomized controlled trials to prevent cardiac events. Recent retrospective analyses have suggested that statins also prevent cancer.

Objectives  To investigate the effect of statin therapy on cancer incidence and cancer death and to analyze the effect of statins on specific cancers and the effect of statin lipophilicity or derivation.

Data Sources  A systematic literature search of MEDLINE, EMBASE, CINAHL, Web of Science, CANCERLIT, and the Cochrane Systematic Review Database through July 2005 was conducted using specific search terms. A review of cardiology and cancer abstracts and manual review of references was also performed.

Study Selection  Twenty-seven of the 8943 articles (n = 86 936 participants) initially identified met the inclusion criteria, reporting 26 randomized controlled trials of statins, with a mean duration of follow-up of at least 1 year, enrolling a minimum of 100 patients, and reporting data on either cancer incidence (n = 20 studies) or cancer death (n = 22 studies).

Data Extraction  All data were independently extracted by 3 investigators using a standardized data abstraction tool. Weighted averages were reported as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model (DerSimonian and Laird methods). Statistical heterogeneity scores were assessed with the Q statistic.

Data Synthesis  In meta-analyses including 6662 incident cancers and 2407 cancer deaths, statins did not reduce the incidence of cancer (OR, 1.02; 95% CI, 0.97-1.07) or cancer deaths (OR, 1.01; 95% CI, 0.93-1.09). No reductions were noted for any individual cancer type. This null effect on cancer incidence persisted when only hydrophilic, lipophilic, naturally derived, or synthetically derived statins were evaluated.

Conclusions  Statins have a neutral effect on cancer and cancer death risk in randomized controlled trials. We found that no type of cancer was affected by statin use and no subtype of statin affected the risk of cancer.

Author Affiliations: University of Connecticut School of Pharmacy, Storrs (Drs Dale, Coleman, Henyan, and White); University of Connecticut School of Medicine, Farmington (Dr Kluger); and Divisions of Cardiology (Drs Dale, Coleman, Henyan, Kluger, and White) and Drug Information (Drs Dale, Coleman, Henyan, and White), Hartford Hospital, Hartford, Conn.

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