Abstract 19669: Incidental Statin Use and the Risk of Stroke or TIA After Radiotherapy for Head and Neck Cancer
Background: There is an increased risk of cerebrovascular events (CVE, stroke and transient ischemic attack (TIA)) after radiotherapy (RT) for head and neck cancer (HNCA). Among broad populations, statins reduce the risk of CVE; yet, there are no data testing the effect of statins on the risk of CVE after neck RT.
Methods: From a single center institutional database, we identified all consecutive subjects with HNCA that underwent carotid RT between 2002 and 2012. Data collection, including cardiovascular and cancer-specific variables, and event adjudication were performed by independent and blinded groups. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. Association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors (age, gender, DM, HTN, HLD, prior CVE, CAD, radiation dose and smoking).
Results: The cohort consisted of 1010 patients (59±13 years, 30% female, 12% DM, 44% HTN, 66% active or prior smokers, mean LDL 101±35 mg/dl). The most common cancer type was oropharyngeal carcinoma. Overall 288 (29%) were on statins and these were more likely to be older, hypertensive and have DM. The median follow-up time from RT was 3.2 yrs (range 1-14 years). In follow-up there were 101 CVE (89 ischemic strokes and 12 TIA’s, rate of 2.5%/yr). The unadjusted rate of stroke and TIA was 1.6%/yr in statin users vs. 3.1% in non-statins users (p=0.03; Figure). The unadjusted rate of ischemic stroke was 1.5%/yr in statin users and 2.4%/yr in non-statin users (p=0.08, Figure). In a multivariable model containing known predictors of CVE, statin use was associated with a reduction in the combination of ischemic stroke and TIA (HR: 0.4, CI 0.2-0.8, p=0.01) and ischemic stroke alone (HR: 0.4, CI 0.2-0.8, p=0.01).
Conclusion: In a large study, incidental statin use was associated with a lower risk of stroke or TIA after radiation therapy for head and neck cancer.
Author Disclosures: D. Addison: None. P. Lawler: None. H. Emami: None. S.A. Janjua: None. P.V. Staziaki: None. T.R. Hallett: None. B. Szilveszter: None. H. Lee: None. O. Hennessy: None. M. Lu: None. N. Mousavi: None. M.G. Nayor: None. F.N. Delling: None. J.M. Romero: None. L.J. Wirth: None. A.W. Chan: None. U. Hoffmann: None. T.G. Neilan: None.
- © 2016 by American Heart Association, Inc.