Statins and the Risk of Cancer after Heart Transplantation
Background—While newer immunosuppressive agents, like mTOR inhibitors, have lowered the occurrence of malignancies after transplantation, cancer is still the leading cause of death late after heart transplantation. Statins may impact on clinical outcomes beyond their lipid-lowering effects. The aim of the present study was to delineate whether statin therapy impacts on cancer risk and total mortality after heart transplantation.
Methods and Results—255 patients who underwent heart transplantation at the University Hospital Zurich between 1985 and 2007 and survived the first year were included. The primary outcome measure was the occurrence of any malignancy, the secondary endpoint overall survival. During follow-up, a malignancy was diagnosed in 108 patients (42%). The cumulative incidence of tumors 8 years after transplantation was reduced in patients receiving a statin (34% vs.13%, 95% CI 0.25-0.43 vs. 0.07-0.18, p<0.003). Statin use was associated with improved cancer-free and overall survival (both p<0.0001). A Cox-regression model analyzing the time to tumor formation with or without statin therapy, adjusted for age, male gender, type of cardiomyopathy and immunosuppressive therapy (including switch to mTOR inhibitors or tacrolimus) demonstrates a superior survival in the statin group. Statins reduced the hazard of occurrence of any malignancy by 67% (HR 0.33, 95% CI 0.21-0.51, p<0.0001).
Conclusions—Although it is not possible to adjust for all potential confounders due to the very long follow-up period, this registry suggests, that statin use is associated with improved cancer-free and overall survival after cardiac transplantation. These data will have to be confirmed in a prospective trial.
- Received November 21, 2011.
- Accepted May 18, 2012.
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