Effect of statin treatment on the risk of cancer in patients with heart failure: A target trial emulation study

Chengsheng Ju; Wallis C. Y. Lau; Pinkie Chambers; Kenneth K. C. Man; Martin D. Forster; Isla S Mackenzie; Charlotte Manisty; Li Wei

doi:10.1002/pds.5775

Effect of statin treatment on the risk of cancer in patients with heart failure: A target trial emulation study

Chengsheng Ju, Wallis C. Y. Lau, Pinkie Chambers, Kenneth K. C. Man, Martin D. Forster, Isla S Mackenzie, Charlotte Manisty, Li Wei (Lead / Corresponding author)

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Abstract

PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.

METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and >6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.

RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. >6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.

CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.

Original language	English
Article number	e5775
Number of pages	12
Journal	Pharmacoepidemiology and Drug Safety
Volume	33
Issue number	3
Early online date	7 Mar 2024
DOIs	https://doi.org/10.1002/pds.5775
Publication status	Published - Mar 2024

Keywords

Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects
Neoplasms/epidemiology
Research Design
Heart Failure/epidemiology
Cognition
heart failure
statin
cancer
target trial emulation
causal inference

ASJC Scopus subject areas

Pharmacology (medical)
Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Final published versionFinal published version, 1.36 MBLicence: CC BY

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title = "Effect of statin treatment on the risk of cancer in patients with heart failure: A target trial emulation study",

abstract = "PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and >6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. >6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.",

keywords = "Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects, Neoplasms/epidemiology, Research Design, Heart Failure/epidemiology, Cognition, heart failure, statin, cancer, target trial emulation, causal inference",

author = "Chengsheng Ju and Lau, {Wallis C. Y.} and Pinkie Chambers and Man, {Kenneth K. C.} and Forster, {Martin D.} and Mackenzie, {Isla S} and Charlotte Manisty and Li Wei",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.",

year = "2024",

month = mar,

doi = "10.1002/pds.5775",

language = "English",

volume = "33",

journal = "Pharmacoepidemiology and Drug Safety",

issn = "1053-8569",

publisher = "Wiley",

number = "3",

}

TY - JOUR

T1 - Effect of statin treatment on the risk of cancer in patients with heart failure

T2 - A target trial emulation study

AU - Ju, Chengsheng

AU - Lau, Wallis C. Y.

AU - Chambers, Pinkie

AU - Man, Kenneth K. C.

AU - Forster, Martin D.

AU - Mackenzie, Isla S

AU - Manisty, Charlotte

AU - Wei, Li

PY - 2024/3

Y1 - 2024/3

N2 - PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and >6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. >6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.

AB - PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and >6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. >6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.

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KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects

KW - Neoplasms/epidemiology

KW - Research Design

KW - Heart Failure/epidemiology

KW - Cognition

KW - heart failure

KW - statin

KW - cancer

KW - target trial emulation

KW - causal inference

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U2 - 10.1002/pds.5775

DO - 10.1002/pds.5775

M3 - Article

C2 - 38450806

SN - 1053-8569

VL - 33

JO - Pharmacoepidemiology and Drug Safety

JF - Pharmacoepidemiology and Drug Safety

IS - 3

M1 - e5775

ER -

Effect of statin treatment on the risk of cancer in patients with heart failure: A target trial emulation study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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