An-Najah Staff

Background: The pleiotropic effects of HMG-CoA reductase inhibitors (statins) have been under investigation in recent years and include improvement of endothelial dysfunction, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory responses, and stabilization of atherosclerotic disease. Additionally, statins have recently been shown to decrease the incidence of VTE in the general population (Glynn RJ et al. NEJM 2009). Our aim in this study was to evaluate the effect of statin use on the incidence of VTE in patients with cancer.
Methods: We performed a chart review of patients diagnosed with cancer in 2006 and 2007 at the Milwaukee Veterans Affairs hospital and identified those who developed a VTE. We also identified patients who were undergoing statin therapy (st+ve) and those not on a statin (st-ve). St+ve was defined as either on a statin at the time of a VTE or 3 consecutive months of use at any point in time in those without a VTE. Proportions were compared using the chi-square test. Survival was analyzed using the Kaplan-Meier estimates and was compared using the log rank test.
Results: Of the 1,175 patients identified, the median age was 65 (25-96), 1,148 were male (98%), and 548 (47%) had received statin therapy. The primary sites of cancer were genito-urinary (40%), lung (20%), gastrointestinal (12%), head/neck (8%), hematological malignancies (5%), liver/pancreas (4%), skin (4%), caner of unknown primary site (3%) and other cancers (4%). Overall, 90 (7.7%) had a documented VTE. The incidence of VTE was 4.7% and 10.2% in st+ve and st- ve patients respectively (p = <0.001). The median survival for all patients was 1300 days. The median survival for patients with and without a VTE was 474 days and 1,300 days respectively (p = <0.0001). The median survival for st-ve and st+ve patients was 980 days and 1300 days respectively (p = 0.001).
Conclusions: Statins decrease the incidence of VTE in cancer patients and may additionally provide a survival benefit. These results should be confirmed in large randomized prospective studies.