Statins and Colorectal Cancer

Paul Lochhead; Andrew T. Chan

Disclosures

Clin Gastroenterol Hepatol. 2013;11(2):109-118. 

In This Article

Statins and Risk of Colorectal Adenomas

Even short-term statin use may be sufficient to influence the evolution or progression of colorectal adenomas, the precursors to the vast majority of colorectal cancers (Table 3). In a retrospective analysis conducted in more than 2500 veterans with a history of colonoscopic polypectomy for adenomas, Siddiqui et al[87] showed a 49% reduction in the incidence of recurrent adenomas, and a 29% reduction in the incidence of advanced adenomas, associated with continuous statin use over 3 to 5 years. In a subsequent analysis of 231 individuals from the same population,[88] significantly fewer adenomas, of smaller size, were observed at follow-up colonoscopy in individuals who had achieved 30% or more reduction in LDL cholesterol level, compared with those who had not. This suggests that lipid lowering, rather than statin use per se, may be partly responsible for the effect of statins on adenoma development and progression.[88] An independent case-control study of 197 patients, also from a veterans population, found no association between statin use and adenoma recurrence over a median of 3.4 years.[89] Furthermore, a secondary analysis of data from 3 large colorectal adenoma chemoprevention trials, with a combined total of 2915 subjects, failed to show any association between statin use and the recurrence of any adenomas, multiple adenomas, or advanced adenomas.[90] The prevalence of self-reported statin use was, however, low (8.1%) across the 3 chemoprevention trials, limiting power for the post hoc analysis.[90] Statin users comprised a much larger proportion (37%) of participants in the Adenoma Prevention With Celecoxib (APC) trial.[91] However, in a secondary analysis of APC trial data, Bertagnolli et al[91] found no evidence to support a chemopreventive effect of statin use over 5 years of follow-up. On the contrary, statin use of more than 3 years was associated with a 39% increased risk of adenoma recurrence. Although these data are derived from an RCT, statin use was self-selected, and the patient population comprised only high-risk patients with a history of multiple or large adenomas, limiting the generalizability of the results. Nonetheless, this analysis represents a large prospective study of statin use and incident adenomas. Furthermore, assessment of the association between statin use and study end points was a planned secondary analysis.[91]

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