Prevalence and association of statin with mortality risk among older US cancer survivors with and without coronary heart disease
J Alifu, C WenliangAbstract
Background
Cancer survivors exhibit high cardiovascular disease prevalence. Statins' pleiotropic effects may improve outcomes, but evidence in those with coronary heart disease remains limited.
Purpose
To investigate statin use prevalence and its association with cause-specific mortality in older U.S. cancer survivors, stratified by coronary heart disease (CHD) status.
Methods
This retrospective cohort study utilized data from four NHANES cycles linked to 2019 mortality files. Statin exposure was identified via prescription medication data. Mortality risks were assessed using Cox proportional hazards models, with survival rates illustrated by Kaplan-Meier curves. Subgroup analyses explored potential effect modifiers.
Results
Among 2,714 cancer survivors (mean age 75.5 years; 54.3% men), 23.9% had CHD (Table 1). Statin prevalence tripled from 20.0% to 56.0%, showing distinct trends by CHD and sex (Figure 1). Over a mean 81-month follow-up, CHD patients using statins had significantly lower all-cause (52.0% vs. 72.8%), cardiac (18.3% vs. 25.9%), and cancer-related mortality (11.5% vs. 18.0%) than non-users (all P<0.05) (Table 2). The Kaplan-Meier curves showed that the statin use demonstrated better survival outcomes across all categories of mortality (all log-rank p < 0.05) (Figure 2). In fully adjusted models, statin use in CHD patients was independently associated with reduced all-cause (HR 0.80), cardiac (HR 0.77), and cancer-related mortality (HR 0.77) (Table 3). No such reduction in cancer mortality was observed in non-CHD individuals (Table 4).
Conclusion
Statin use is associated with significantly reduced cause-specific mortality in older cancer survivors with CHD, but not in those without CHD. Personalizing statin therapy based on CHD status may optimize survival outcomes.Abstract Picture 1 Abstract Picture 2