Statins plus Aspirin Improve Overall Survival in Uterine Malignancies
CHICAGO—Women with uterine malignancies who took statins and aspirin—but not beta-blockers—had an 84% reduction in mortality, while use of statins alone reduced mortality by 45%, a study presented at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting has found.
“These data are important as we explore the use of statins in patients with conditions beyond cardiovascular disease,” said lead author Nicole Nevadunsky, MD, gynecologic oncologist, Montefiore Einstein Center for Cancer Care and Assistant Professor, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine of Yeshiva University, and colleagues.
The investigators retrospectively reviewed consecutive patients with uterine malignancies diagnosed between January 2005 and December 2009. “We measured the association between statin use, aspirin use, and beta-blocker use at the time of initial diagnosis and overall survival (OS),” the authors noted. “Our aim was to examine the potential associations between uterine malignancies, statins, and the polypharmacy associated with cardiovascular disease.”
They abstracted age; race; diagnosis of hyperlipidemia, diabetes or hypertension; medications (statins, beta-blockers, and aspirin); pathology; and exposure to chemotherapy or radiation at the time of initial diagnosis and treatment.
Of the 554 patients identified, 333 (60%) were not hyperlipidemic; 165 (30%) were hyperlipidemic and on statins; and 56 (10%) were hyperlipidemic and not on statin therapy. A total of 68 women were taking both statins and aspirin.
“Women who used statins were older, diabetic, hypertensive, [and] used beta-blockers and aspirin,” Dr. Nevadunsky noted. Stage, grade, and use of chemotherapy were similar among the groups; however, those who were hyperlipidemic had received radiation more frequently whether they were on statins or not.
Among the women, 175 were taking beta-blockers and 365 were not. Univariate analysis showed the hazard ratio (HR) for effect of beta-blocker use to be 1.41 (95% CI: 0.99-2.02; P=0.06).
Kaplan-Meier analysis showed that compared with patients who were not hyperlipidemic, those who were hyperlipidemic had improved survival; again, regardless of whether they were on statins or not (P=0.036).
When the hyperlipidemia groups were stratified by aspirin use, they found that those who used statins plus aspirin had significantly improved OS compared with other aspirin users (P=0.01).
“On multivariate analysis, women who used statins had 45% decreased hazard of death compared to women who were not hyperlipidemic (HR, 0.55; 95% CI: 0.35-0.87),” they found. In addition, “aspirin users had improved survival compared to nonusers (HR, 0.47; 95% CI: 0.29-0.76).”
Compared with the other groups, women using both statins and aspirin had an 84% decreased hazard of death (HR, 0.16; 95% CI: 0.07-0.38; P<0.01).
“It is not uncommon for women in their 50s and 60s to take statins and aspirin to treat cardiovascular conditions like high cholesterol or hypertension. Given the clear association we saw between statin and aspirin use and improved cancer survival, further evaluation is warranted to help us better understand how these medications may improve survival in endometrial and other cancers,” Dr. Nevadunsky said.