Jenny N. Poynter, M.P.H., Stephen B. Gruber, M.D., Ph.D., M.P.H., Peter D.R. Higgins, M.D., Ph.D., Ronit Almog, M.D., M.P.H., Joseph D. Bonner, M.S., Hedy S. Rennert, M.P.H., Marcelo Low, M.P.H., Joel K. Greenson, M.D., and Gad Rennert, M.D., Ph.D.
Background Statins are inhibitors of 3-hydroxy-3-methylglutarylcoenzyme A reductase and effective lipid-lowering agents. Statinsinhibit the growth of colon-cancer cell lines, and secondaryanalyses of some, but not all, clinical trials suggest thatthey reduce the risk of colorectal cancer.
Methods The Molecular Epidemiology of Colorectal Cancer studyis a population-based case–control study of patients whoreceived a diagnosis of colorectal cancer in northern Israelbetween 1998 and 2004 and controls matched according to age,sex, clinic, and ethnic group. We used a structured interviewto determine the use of statins in the two groups and verifiedself-reported statin use by examining prescription records ina subgroup of patients for whom prescription records were available.
Results In analyses including 1953 patients with colorectalcancer and 2015 controls, the use of statins for at least fiveyears (vs. the nonuse of statins) was associated with a significantlyreduced relative risk of colorectal cancer (odds ratio, 0.50;95 percent confidence interval, 0.40 to 0.63). This associationremained significant after adjustment for the use or nonuseof aspirin or other nonsteroidal antiinflammatory drugs; thepresence or absence of physical activity, hypercholesterolemia,and a family history of colorectal cancer; ethnic group; andlevel of vegetable consumption (odds ratio, 0.53; 95 percentconfidence interval, 0.38 to 0.74). The use of fibric-acid derivativeswas not associated with a significantly reduced risk of colorectalcancer (odds ratio, 1.08; 95 percent confidence interval, 0.59to 2.01). Self-reported statin use was confirmed for 276 ofthe 286 participants (96.5 percent) who reported using statinsand whose records were available.
Conclusions The use of statins was associated with a 47 percentrelative reduction in the risk of colorectal cancer after adjustmentfor other known risk factors. Because the absolute risk reductionis likely low, further investigation of the overall benefitsof statins in preventing colorectal cancer is warranted.
Source Information
From the Departments of Epidemiology (J.N.P., S.B.G.), Internal Medicine (S.B.G., P.D.R.H., J.D.B.), Human Genetics (S.B.G.), and Pathology (J.K.G.), University of Michigan, Ann Arbor; and the Department of Community Medicine and Epidemiology, Carmel Medical Center and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology and Clalit Health Services National Cancer Control Center — both in Haifa, Israel (R.A., H.S.R., M.L., G.R.).
Address reprint requests to Dr. Gruber at the Division of Molecular Medicine and Genetics, University of Michigan, 4301 MSRB III, Ann Arbor, MI 48109-0638, or at sgruber{at}umich.edu.
Statins and the Risk of Colorectal Cancer
Setoguchi S., Avorn J., Schneeweiss S., Maisonneuve P., Eng. , Lowenfels A. B., Welch H. G., Poynter J. N., Gruber S. B., Rennert G.
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N Engl J Med 2005;
353:952-954, Sep 1, 2005.
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