The relationship between statins and colorectal cancer stage in the Women's Health Initiative.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1540-1540
Author(s):  
Brian Rutledge ◽  
Pinkal M. Desai ◽  
Mahmoud Abdel-Rasoul ◽  
Rami Nassir ◽  
Lihong Qi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Women's Health ◽  
Late Stage ◽  
Time Dependent ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Health Initiative ◽  
The Relationship ◽  
Statin Use ◽  
The Women’S Health Initiative

1540 Background: Statins are the most widely prescribed cholesterol-lowering drugs in the United States. The anti-carcinogenic effect of statins may reduce the metastatic potential of cancer cells leading to ‘stage migration’ with users more likely diagnosed with early rather than late stage cancer. We evaluated the relationship between prior statin use and colorectal cancer (CRC) stage at diagnosis in the Women’s Health Initiative (WHI). Methods: The study population included 132,322 post-menopausal women aged 50-79 years, among which there were 2,628 pathologically confirmed cases of insitu (3.3%), local (43.6%), regional (40.4%) and distant (12.7) stage CRC, after an average of 13.9 (SD = 4.7) years of follow-up. To reduce the possibility of detection bias among women more likely to be prescribed statins, we excluded women who did not report a mammogram within 5 years of study entry and who had no health insurance or medical care provider (n = 28,237). Stage was coded using criteria implemented in the Surveillance, Epidemiology and End Results (SEER) Program into early (in situ and local) vs. late (regional and distant) stage disease. Information on statin use prior to diagnosis was collected by self and interviewer-administered questionnaires at baseline and at one, three, six and nine years post-baseline. Self- and interviewer-administered questionnaires were used to collect risk factor information. Hazards ratios (HR) and 95% confidence intervals (CIs) evaluating the relationship between statin use at baseline only, and in a time-dependent manner, and diagnosis of late-stage CRC were computed from multivariable-adjusted Cox proportional hazards analyses. Statistical tests were two-sided. Results: Statins were used by 10,868 women (8%) at baseline. There was no significant relationship between statin use at baseline and late stage CRC cancer (HR = 1.03, 95% CI (0.82-1.30) and no significant association by type of statin or duration of use. In the multivariable-adjusted time-dependent model, use of statins was associated with a reduction in diagnosis of late-stage colorectal cancer (HR 0.79, 95% CI 0.67-0.94, p = 0.007). Conclusions: Prior statin use may have an influence on colorectal cancer stage at diagnosis.

Prospective Analysis Of Statin Use and Risk Of Non-Hodgkin’s Lymphoma In The Women’s Health Initiative Cohort

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4279-4279
Author(s):  
Pinkal Desai ◽  
Robert Wallace ◽  
Matthew Anderson ◽  
Abdel Alqwasmi ◽  
Barbara V. Howard ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Women's Health ◽  
Lower Risk ◽  
Hodgkin's Lymphoma ◽  
Women's Health Initiative ◽  
Health Initiative ◽  
Non Hodgkin's Lymphoma ◽  
The Relationship ◽  
Statin Use ◽  
The Women’S Health Initiative

Abstract Introduction HMG CoA reductase inhibitors (statins) are a class of cholesterol lowering drugs that affect many intracellular pathways and have implications for cancer chemo prevention. Statins have been shown to induce a phosphoprotein signature that shuts MYC activation and also have anti-inflammatory activity that may impact the risk of Non-Hodgkin’s lymphoma (NHL). Results from observational studies on the relationship between statin use and NHL are conflicting. We analyzed data from the Women’s Health Initiative (WHI) to assess the relationship between statins and the risk of NHL. Methods The study population included 161,563 post-menopausal women ages 50-79 years. Women with incident NHL were identified over an average of 10.8 (SD +3.3) years of follow-up. Information on statin use was collected at study entry and at years 1, 3, 6 and 9. Statins were classified as lipophilic (simvastatin, lovastatin, fluvastatin) or hydrophilic (pravastatin, atorvastatin) by potency (low, medium, high) and by duration of use. Self and interviewer-administered questionnaires were used to collect information on other risk factors. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the relationship between statin use and NHL risk as a time-dependent exposure. Multivariable models were stratified by WHI trial, extension study and age group and were adjusted for education, ethnicity, smoking, alcohol, body mass index, waist circumference, % energy from fat, hormone therapy use, physical activity, current medical provider and history of lupus and rheumatoid arthritis. A separate analysis was performed for individual NHL subtypes: Diffuse Large B cell Lymphoma (DLBCL) (n=228), follicular lymphoma (n=169) and Small Lymphocytic Lymphoma/Chronic Lymphocytic Lymphoma (SLL/CLL) (n=74).All statistical tests were two-sided. Results Statins were used at baseline by 12,243 women (7.5%), 8266 of whom used lipophilic agents. The multivariable adjusted HR of overall statin use and risk of NHL was 0.66 (95% CI: 0.48-0.90). Hydrophilic statin use was associated with a significantly lower risk of developing NHL (HR 0.47, 95% C.I. 0.27-0.81); HR for pravastatin 0.46 (95% C.I. 0.20-1.02) and for atorvastatin 0.39 (95% C.I. 0.124-1.20). Lipophilic statins were not associated with NHL risk (HR 0.85, 95% C.I. 0.58-1.24). Among NHL subtypes, statin use was associated with a lower risk of DLBCL (HR 0.49, 95% C.I. 0.25-0.96) however there was no association with follicular lymphoma (HR 0.92, 95% C.I. 0.49-1.70) or CLL/SLL (HR 1.18, 95% C.I. 0.50-2.75). Conclusion Prior use of statins was associated with a lower overall risk of NHL attributable to a lower risk of DLBCL in the WHI cohort. This effect was largely seen among users of hydrophilic statins. Disclosures: Safford: Amgen: Research Funding.

scholarly journals The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women’s health initiative observational cohort

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037945
Author(s):  
Victor A Eng ◽  
Sean P David ◽  
Shufeng Li ◽  
Mina S Ally ◽  
Marcia Stefanick ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Women's Health ◽  
Smoking Status ◽  
Cancer Stage ◽  
Health Initiative ◽  
Screening Services ◽  
Former Smokers ◽  
Never Smokers ◽  
The Women’S Health Initiative

ObjectiveTo assess the dose-dependent relationship between smoking history and cancer screening rates or staging of cancer diagnoses.DesignProspective, population-based cohort study.SettingQuestionnaire responses from the Women’s Health Initiative (WHI) Observational Study.Participants89 058 postmenopausal women.Outcome measuresLogistic regression models were used to assess the odds of obtaining breast, cervical, and colorectal cancer screening as stratified by smoking status. The odds of late-stage cancer diagnoses among patients with adequate vs inadequate screening as stratified by smoking status were also calculated.ResultsOf the 89 058 women who participated, 52.8% were never smokers, 40.8% were former smokers, and 6.37% were current smokers. Over an average of 8.8 years of follow-up, current smokers had lower odds of obtaining breast (OR 0.55; 95% CI 0.51 to 0.59), cervical (OR 0.53; 95% CI 0.47 to 0.59), and colorectal cancer (OR 0.71; 95% CI 0.66 to 0.76) screening compared with never smokers. Former smokers were more likely than never smokers to receive regular screening services. Failure to adhere to screening guidelines resulted in diagnoses at higher cancer stages among current smokers for breast cancer (OR 2.78; 95% CI 1.64 to 4.70) and colorectal cancer (OR 2.26; 95% CI 1.01 to 5.05).ConclusionsActive smoking is strongly associated with decreased use of cancer screening services and more advanced cancer stage at the time of diagnosis. Clinicians should emphasise the promotion of both smoking cessation and cancer screening for this high-risk group.

Abstract 27: Statin use and risk of hemorrhagic stroke in a community-based cohort of aging women: The Women’s Health Initiative

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Elena Salmoirago-Blotcher ◽  
Kathleen M Hovey ◽  
Judith K Ockene ◽  
Chris A Andrews ◽  
Jennifer Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Women's Health ◽  
Hemorrhagic Stroke ◽  
Extension Study ◽  
Prior History ◽  
Health Initiative ◽  
Increased Risk ◽  
History Of ◽  
Statin Use ◽  
The Women’S Health Initiative

Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with increased risk of hemorrhagic stroke among women enrolled in the Women’s Health Initiative (WHI). Methods: This secondary data analysis was conducted among 68,132 women enrolled in the WHI Clinical Trials (CTs). Participants were 50 to 79 yrs old; postmenopausal; and were followed through 2005 (parent study) and for an additional 5 yrs (through September 30, 2010) in the WHI extension study. Statin use was assessed at baseline and at follow-up (FU) visits at 1, 3, 6, and 9 years. Women brought all medications in original containers for inventory. Strokes were self-reported annually and adjudicated by medical record review. Risk of hemorrhagic stroke by statin use (modeled as a time-varying covariate, with the “no use” category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for hemorrhagic stroke (model 2); and possible confounders by indication (model 3). All models adjusted for enrollment in the different CTs and in the extension study. Participants were censored at the date of last contact or loss to FU. Pre-specified subgroup analyses were conducted according to use or non-use of antiplatelet medications (including aspirin) or anticoagulants, and prior history of stroke. Results: Final models included 67,882 women (mean age at baseline 63 ± 7 yrs). Over a mean FU of 12 yrs, incidence rates of hemorrhagic stroke were 6.4/10,000 person-years among women on statins and 5.0/10,000 person-years among women not taking statins. The unadjusted risk of hemorrhagic stroke in statin users vs. non-users was 1.21 (CI: 0.96, 1.53). The HR was attenuated to 0.98 (CI: 0.76, 1.26) after adjusting for age, hypertension, and other risk factors for hemorrhagic stroke. Planned subgroups analyses showed that women taking both statins and antiplatelet agents had a higher risk of hemorrhagic stroke than women taking antiplatelet medications without statins (HR: 1.59; CI: 1.02, 2.46), whereas women not taking antiplatelet medications had no risk elevation with statins (HR=0.79; CI: 0.58-1.08); P for interaction = .01. No significant interactions were found for anticoagulant use or prior history of stroke, but the statistical power for these analyses was low. Conclusion: Statin use was not associated with an overall increased risk of hemorrhagic stroke among older community-dwelling women. However, women taking statins in conjunction with antiplatelet medications had elevated risk; a finding that warrants further study and potential incorporation into clinical decision making.

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