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Statins and colorectal cancer risk: a longitudinal study

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Abstract

Purpose

Studies evaluating the association between statins and colorectal cancer (CRC) have used various methods to address bias and have reported mixed findings. We sought to assess the association in a large cohort of residents in Emilia-Romagna, Italy, using multiple methods to address different sources of confounding. We also sought to explore potential effect measure modification by sex.

Methods

We conducted a retrospective cohort study using the 2003–2010 healthcare database of Emilia-Romagna, Italy. We identified all initiators of statins; initiators of glaucoma medications served as the comparison group to account for confounding by healthy user bias. We followed patients longitudinally to identify CRC cases in hospital discharge data. We used multivariable Cox regression analyses to adjust for confounding by CRC risk factors and we conducted a sensitivity analysis using propensity score matching.

Results

After multivariable adjustment, initiators of statins had a lower incidence rate of CRC as compared to initiators of glaucoma drugs [hazard ratio (HR) 0.79; 95 % CI 0.69–0.90]. In sex-stratified analyses we observed a protective effect in men (HR 0.77; 95 % CI 0.67–0.88) but not in women (HR 0.96; 95 % CI 0.82–1.1). Results were similar in propensity score analyses.

Conclusions

After adjusting for observed risk factors, statin initiation versus glaucoma drug initiation was associated with a reduced risk of CRC in men but not in women. While this study is subject to many limitations, it corroborates a previous study that found sex differences in the association between statins and CRC.

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Acknowledgments

We thank Roberto Grilli, MD, from the Regional Health Care and Social Agency, Regione Emilia-Romagna, Italy; Eleonora Verdini, BS, from the Health Care Authority, Regione Emilia-Romagna, Italy; Daniel Z. Louis, MS, from the Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, PA, USA; and Emanuela Masini, MD, from the School of Medicine, University of Florence, Italy. VM affirms that everyone who contributed significantly to this work has been listed. This research was supported through a collaborative agreement between the Regional Health Care and Social Agency, Regione Emilia-Romagna, Italy; the Health Care Authority, Regione Emilia-Romagna, Italy; and the Thomas Jefferson University, Philadelphia, PA, USA. The authors’ work was independent of the funders, and this paper accurately represents the study results. The study sponsors played no roles in the design or conduct of the study; in the collection, management, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Jefferson School of Population Health, Thomas Jefferson University, 1015 Walnut St., Suite 115, Philadelphia, PA, 19107, USA

    Zoe Clancy & Vittorio Maio

  2. Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA

    Scott W. Keith

  3. Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Carol Rabinowitz

  4. School of Specialization in Applied Pharmacology, University of Florence, Florence, Italy

    Matteo Ceccarelli

  5. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Joshua J. Gagne

Authors
  1. Zoe Clancy
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  2. Scott W. Keith
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Correspondence to Vittorio Maio.

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Clancy, Z., Keith, S.W., Rabinowitz, C. et al. Statins and colorectal cancer risk: a longitudinal study. Cancer Causes Control 24, 777–782 (2013). https://doi.org/10.1007/s10552-013-0160-x

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  • DOI: https://doi.org/10.1007/s10552-013-0160-x

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