Associations Between Post-Diagnostic Statin Use, Cholesterol Levels, and Mortality Risk Among American Breast Cancer Patients: Insights from the National Health and Nutrition (NHANES) Survey
Author(s)
Mohin Chanpura, MS1, Sarah Axeen, PhD2;
1University of Southern California, Alfred E. Mann School of Pharmacy, Los Angeles, CA, USA, 2University of Southern California, Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
1University of Southern California, Alfred E. Mann School of Pharmacy, Los Angeles, CA, USA, 2University of Southern California, Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
Presentation Documents
OBJECTIVES: HMG-CoA reductase inhibitors, or statins, represent a class of lipid lowering agents hypothesized to lower both breast cancer-specific mortality and breast cancer recurrence risk. Although the underlying biological mechanisms of these effects remain elusive, emerging data suggests that manipulating patients’ cholesterol levels may induce immunogenic, antitumor responses. As such, the objective of this analysis was to assess whether post-diagnostic statin use led to differential cancer-specific mortality among a representative sample of female breast cancer patients in the United States over a 20-year span after accounting for differences in patients’ lipid profiles.
METHODS: This case-control analysis was performed using data from n=667 female breast cancer patients who participated in NHANES from 1999-2018. SAS® v9.4 was used to link patients’ demographic, medical, prescription, and lipid lab information with public-use mortality records from 2019. Control variables included age at diagnosis, age at NHANES screening interview, race, and comorbid hypertension, diabetes, or coronary heart disease. To adjust for the effects of time on mortality, we restricted our final analysis to n=292 participants from 1999-2008.
RESULTS: Statin use, validated using corresponding pill containers, was associated with a 24% reduction in cancer-specific mortality risk (OR 0.76, 95% CI: 0.36-1.62; p=0.48). By contrast, elevated lipid profiles post-diagnosis were associated with a 19% increase in cancer-specific mortality risk (OR 1.19, 95% CI: 0.60-2.36; p=0.63). With respect to a subgroup of n=63 participants from 1999-2010 with comorbid diabetes diagnoses, we found that validated post-diagnostic statin use was associated with significantly reduced cancer-specific mortality risk (OR 0.11, 95% CI: 0.01-0.92; p=0.04), while elevated lipid profiles were not associated with increased cancer-specific mortality risk.
CONCLUSIONS: As diabetes-associated insulin resistance plays a known role in breast cancer tumorigenesis, our subgroup analysis suggests that statins may possess certain other antitumorigenic properties beyond the cholesterol reduction pathway.
METHODS: This case-control analysis was performed using data from n=667 female breast cancer patients who participated in NHANES from 1999-2018. SAS® v9.4 was used to link patients’ demographic, medical, prescription, and lipid lab information with public-use mortality records from 2019. Control variables included age at diagnosis, age at NHANES screening interview, race, and comorbid hypertension, diabetes, or coronary heart disease. To adjust for the effects of time on mortality, we restricted our final analysis to n=292 participants from 1999-2008.
RESULTS: Statin use, validated using corresponding pill containers, was associated with a 24% reduction in cancer-specific mortality risk (OR 0.76, 95% CI: 0.36-1.62; p=0.48). By contrast, elevated lipid profiles post-diagnosis were associated with a 19% increase in cancer-specific mortality risk (OR 1.19, 95% CI: 0.60-2.36; p=0.63). With respect to a subgroup of n=63 participants from 1999-2010 with comorbid diabetes diagnoses, we found that validated post-diagnostic statin use was associated with significantly reduced cancer-specific mortality risk (OR 0.11, 95% CI: 0.01-0.92; p=0.04), while elevated lipid profiles were not associated with increased cancer-specific mortality risk.
CONCLUSIONS: As diabetes-associated insulin resistance plays a known role in breast cancer tumorigenesis, our subgroup analysis suggests that statins may possess certain other antitumorigenic properties beyond the cholesterol reduction pathway.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH179
Topic
Epidemiology & Public Health
Disease
SDC: Geriatrics, SDC: Oncology, STA: Generics