Statins & ADT.

[pjoshea13]

New study below. ("... online 7 December 2018", but I don't recall it being posted here yet.)

"The national VA database was used to identify all men diagnosed with CaP who were treated with ADT for at least 6 months between 2000 and 2008 with follow-up through May 2016."

"A total of 87,346 patients on ADT were included in the study cohort, 53,360 patients used statins and 33,986 did not.

"Statin users were younger in age (median 73 vs. 76 ...), more likely to have a higher Charlson comorbidity index (CCI) >3 (3.1% vs. 2.5% ...) and more likely to have a high grade (Gleason score 8–10) cancer (12.3% vs. 10.9% ...).

"Statin users had longer {overall survival} (median 6.5 vs. 4.0 years ...) and decreased death from CaP (5-year {CaP-specific survival} 94.0% vs. 87.3% ...).

"Statin use was also associated with longer time to a {skeletal related events} (median 5.9 vs. 3.7 years ...).

"On multivariable Cox proportional hazards analysis with inverse propensity score weighted, statin use was an independent predictor of improved {overall survival} (hazard ratio [HR] 0.66 ...), {CaP-specific survival} (HR 0.56 ...), and {skeletal related events} (HR 0.64 ...) when controlling for age, race, Charlson comorbidity index, prostate-specific antigen, and Gleason score."

-Patrick

sciencedirect.com/science/a...

The impact of statins in combination with androgen deprivation therapy in patients with advanced prostate cancer: A large observational study

Author links open overlay panelIndiaAnderson-CarterB.S.aNataszaPosielskiM.D.aJinn-ingLiouM.S.bTariq A.KhemeesM.D.aTracy M.DownsM.D.aE. JasonAbelM.D.aDavid F.JarrardM.D.aKyle A.RichardsM.D.ac

a

The University of Wisconsin-Madison, Department of Urology, Madison, WI

b

The University of Wisconsin-Madison, Department of Medicine, Madison, WI

c

William S. Middleton Memorial Veterans Hospital, Department of Surgery, Section of Urology, Madison, WI

Received 27 July 2018, Revised 9 November 2018, Accepted 19 November 2018, Available online 7 December 2018.

Show less

doi.org/10.1016/j.urolonc.2... rights and content

Highlights

•

Objective: assess statin use on outcomes in men with advanced prostate cancer.

•

Patients in this study had advanced cancer on androgen deprivation therapy.

•

Statin use associated with improved oncologic outcomes in Veterans.

Abstract

Background

Statins are thought to possess antineoplastic properties related to their effect on cell proliferation and steroidogenesis. Progression to castrate resistant prostate cancer (CaP) includes de-regulation of androgen synthesis suggesting a role for statins in this setting. Our goal was to assess the role of statin use on oncologic outcomes in patients with advanced CaP being treated with androgen deprivation therapy (ADT).

Methods

The national VA database was used to identify all men diagnosed with CaP who were treated with ADT for at least 6 months between 2000 and 2008 with follow-up through May 2016. Our cohort was stratified based on statin use of at least 6 months duration during the same time. Multivariable Cox proportional hazards analyses with inverse propensity score weighted (IPSW) adjustment were calculated to assess for primary outcomes of CaP-specific survival (CSS), overall survival (OS) and skeletal related events (SREs).

Results

A total of 87,346 patients on ADT were included in the study cohort, 53,360 patients used statins and 33,986 did not. Statin users were younger in age (median 73 vs. 76, P < 0.001), more likely to have a higher Charlson comorbidity index (CCI) >3 (3.1% vs. 2.5%, P < 0.001) and more likely to have a high grade (Gleason score 8–10) cancer (12.3% vs. 10.9%, P < 0.001). Statin users had longer OS (median 6.5 vs. 4.0 years P < 0.001) and decreased death from CaP (5-year CSS 94.0% vs. 87.3%, P < 0.001). Statin use was also associated with longer time to a SRE (median 5.9 vs. 3.7 years, P < 0.001). On multivariable Cox proportional hazards analysis with inverse propensity score weighted, statin use was an independent predictor of improved OS (hazard ratio [HR] 0.66, confidence interval [CI] 0.63–0.68; P < 0.001), CSS (HR 0.56, 95% CI 0.53–0.60; P < 0.001), and SREs (HR 0.64, 95%CI 0.59–0.71; P < 0.001) when controlling for age, race, Charlson comorbidity index, prostate-specific antigen, and Gleason score.

Conclusion

The use of statins in men on ADT for CaP is associated with improved CSS and OS. Statins are inexpensive, well-tolerated medications that offer a promising adjunct to ADT, but require further prospective studies.

Keywords

Prostatic neoplasmsHydroxymethylglutaryl-CoA reductase inhibitorsGonadotropin-releasing hormone/analogs and derivativesHospitalsVeterans

Abbreviations

ADTandrogen deprivation therapyIPSWinverse propensity score weightedCCICharlson comorbidity indexOSoverall survivalCaPprostate cancerCSSprostate cancer-specific survivalPSAprostate-specific antigenSREskeletal related eventVAVeterans Health Administration

[HopingForTheBest1]

Does a person need to be diagnosed with high cholesterol to be prescribed a statin; and was a specific beneficial therapeutic dose addressed in the study?

[pjoshea13 in reply to HopingForTheBest1]

10+ years ago, my GP would not give me Metformin, etc, but he had no hesitation when I asked for Simvastatin at the highest dose. There's a crazy idea that a lower cholesterol is always better - no matter how good your numbers. But, from 2009:

"A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines." [1]

In 2012-13, 27.8% of thos over age 40 in the U.S. were on a statin [2].

From 2014: "Huh? 87 Percent of Men Age 60-Plus Should Take a Statin?" [3].

In other words, it's easy to get a script.

I don't know if the full text of the study mentions the best type of statin & dose, but other studies indicate that higher doses may be better.

-Patrick

[1] newsroom.ucla.edu/releases/...

[2] jamanetwork.com/journals/ja...

[3] blog.aarp.org/2014/03/20/hu...

[NPfisherman]

Great find....Thank you Patrick....

[kmack57]

Thanks Patrick!

[j-o-h-n]

And sthat's a fact...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/28/2019 5:13 PM EST