Statins and Colorectal Cancer

Paul Lochhead; Andrew T. Chan

Disclosures

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

In This Article

Statins and Combination Chemoprevention

Even if statins, when used alone, are judged to be ineffective at reducing the risk of colorectal neoplasia, their use in combination with other agents, such as NSAIDs or aspirin, may still prove to be a successful chemopreventive strategy.[98] Experimental evidence suggests that statins act synergistically with NSAIDs, and cyclooxygenase-2 inhibitors, to induce cell-cycle arrest and apoptosis in human colorectal cancer cell lines.[40,99] In an animal model, statins, in combination with NSAIDs or aspirin, markedly reduce the incidence and multiplicity of azoxymethane-induced colon tumors.[47,100] In addition, atorvastatin greatly enhances the chemopreventive efficacy of celecoxib in the Min mouse model of familial adenomatous polyposis.[50]

In the German population-based case-control study,[27] the combined use of statins and low-dose aspirin for at least 5 years was associated with a striking 62% reduction in the risk of colorectal cancer. However, 5 other case-control studies[26,67,69,70,72] and 2 large prospective cohort studies[76,84] reported a lack of interaction between NSAIDs, aspirin, or cyclooxygenase-2 inhibitors and statin use. Furthermore, in the secondary analysis of data from 3 large adenoma chemoprevention trials, no differences in the risk ratios were observed between strata of aspirin or NSAID use.[90] The ongoing National Surgical Adjuvant Breast and Bowel Project P-5 clinical trial permits entry of patients already taking aspirin, and a planned secondary analysis is the assessment of the potential effect modification of rosuvastatin by aspirin.[97]

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