Statins linked to 20% lower colorectal cancer risk
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Statins used in the general population conferred a 20% risk reduction for colorectal cancer with a possibly larger impact in patients with inflammatory bowel disease, according to an analysis presented during ACG 2020 Virtual.
“We found that statin use was associated with a significant risk reduction of colorectal cancer in the non-IBD population whereby the risk reduction was 20%,” Kevin N. Singh, MD, from NYU Langone Medical Center, said during his virtual presentation. “We found that statin users were noted to have a 60% lower risk of colorectal cancer in the IBD population.”
Singh and colleagues conducted a meta-analysis of 52 studies that included 17 cohort studies, 27 case-control studies and eight randomized clinical trials, all totaling more than 11 million patients.
In the non-IBD population, the pooled CRC OR was 0.8 (95% CI, 0.73-0.88) and researchers found no publication bias. In a separate analysis, Singh said the risk for CRC with statin use in the IBD population was 60% lower than in the general population. This analysis included five observational studies with more than 15,000 patients with IBD. Pooled OR was 0.4 (95% CI, 0.19-0.86), though the researchers did identify a publication bias. Singh said formal studies need to be performed.
“The risk reduction of statins may actually be greater than previously reported. Prospective randomized trials are needed to confirm this association and future studies should also focus on determining whether the chemopreventive effects of statins differ between ulcerative colitis and Crohn’s disease patients,” he said.
Perspective
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Carole Macaron, MD
It is debatable whether statins are chemopreventive agents against CRC. Experimental studies support the antineoplastic effect of statins via their anti-inflammatory, anti-proliferative and pro-apoptotic effects but observational and population studies are equivocal. While large population-based studies failed to show any significant benefit, some observational studies have suggested small CRC risk reduction. Moreover, results from randomized clinical trials are not conclusive as they were obtained from studies that were not powered to assess the role of statin in CRC prevention.
In the IBD population, the data are even more limited. There are fewer studies, and most are limited due to lack of reporting of disease duration, colonic involvement, concomitant PSC, among other factors. The current meta-analysis by Singh and colleagues suggests possible beneficial effect in sporadic cancer and maybe a greater effect in patients with IBD. This is consistent with some previously published meta-analyses. But does this mean we should settle for statin to reduce someone’s risk for developing colon cancer?
For now, it appears that statins may reduce colon cancer risk in the IBD and non-IBD population, but this remains to be confirmed. The protective effect has to be proven and validated in large, randomized trials designed and powered for CRC prevention as the primary outcome.
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Singh KN, et al. S0265. Presented at the American College of Gastroenterology Annual Scientific Meeting (Virtual). Oct 23-28.
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