In a retrospective study of more than 15,000 Taiwanese patients newly diagnosed with non-Hodgkin lymphoma (NHL), those patients who were regular statin users had fewer heart failure events and had an improved overall survival (OS) compared to non-statin users. The survival benefit was more pronounced for those patients who had a longer statin exposure. These results were published as a letter in JACC: CardioOncology.1
A study published in 2023 showed that exposure to statins could reduce the risk of anthracycline- linked cardiac dysfunction among patients with lymphoma.2 For the current retrospective study, Yi-Heng Li, MD, PhD, of the Department of Internal Medicine at the National Cheng Kung University Hospital in Tainan, Taiwan, and his colleagues followed up on the prior results to understand whether there is an association between the use of statins and heart failure and OS among patients with lymphoma.
Dr. Li and his colleagues identified 15,466 adult patients with newly diagnosed NHL between 2012 and 2019 from the Taiwan National Health Insurance Research Database (NHIRD) and the National Cancer Registry. Statin users were defined as those who received a statin within the six months prior to their lymphoma diagnosis and took statins for more than 90% of the subsequent 30-day period. The mean patient age was 62.7 years, 55% were male, and 14.6% were statin users.
Among the patients, 70.4% had aggressive histology, 88% had B-cell lymphoma, including 54.3% with diffuse large B-cell lymphoma, 12.9% with follicular lymphoma, and 11.5% with marginal zone lymphoma. Following 1:2 propensity score matching between statin users and non-users, most covariates were well balanced, except for slightly higher proportions of coronary artery disease and diabetes in statin users.
After a mean follow-up of 3.4 years, the cumulative incidence of heart failure was 9.3% (95% CI 8.3-10.4) in the non-statin user group compared to 7.7% (95% CI 6.4-9.1) among statin users. Statin use resulted in a 19% lower risk of heart failure events (adjusted hazard ratio [HR] = 0.81; 95% CI 0.66-0.99), and those with longer statin exposure had a 32% lower risk compared to non-statin users (HR=0.68; 95% CI 0.52-0.86).
The cumulative incidence of death was 45.6% (95% CI 42.6-48.9) among statin users compared to 50.3% (95% CI 48.0-52.6) in the non-statin user group. The statin user group also showed improved OS (HR=0.89; 95% CI 0.82-0.96) compared to the non-statin user group.
There were 44 cardiovascular (CV) deaths, with a cumulative incidence of 0.6% (95% CI 0.3-1.1) in statin users compared to 0.9% (95% CI 0.6-1.3) in non-statin users. Although numerical reductions in both CV deaths and cancer-related deaths were observed in statin users, only the reduction in cancer-related deaths reached statistical significance.
The cumulative incidence of cancer death was 29.8% (95% CI 27.4-32.5) in statin users compared to 35.0% (95% CI 33.1-37.0) among non-statin users; statin users had a 17% lower risk of cancer death compared to non-statin users (adjusted HR=0.83; 95% CI 0.75-0.92). There were no differences in the risk for arterial events and venous events between the two groups.
According to the authors, the exact mechanisms of the potential benefit of statins on patients with cancer remain unknown, although others have proposed that the mechanism may be statin effects on inflammation and oxidation.
The strengths of the current study include a large sample size, tracking of many clinical factors for each patient within the NHIRD, including staging and histology data. Limitations of the study include its retrospective design and potential unmeasured confounders that may exist despite matching of available comorbidities and medications within the patients in the dataset. Furthermore, certain data were missing for patients, including body mass index, smoking history, and laboratory data, in addition to the possibility that while cancer-related deaths were in the patients’ records, the true number of CV deaths may be underestimated in this retrospective dataset.
The authors emphasized the need for prospective and randomized studies to better evaluate the potential benefit of statin use among patients with lymphoma.
Any conflicts of interest declared by the authors can be found in the original article.
References
- Chen CY, Chang WT, Lin HW, et al. Statin use is associated with reduced heart failure and risk of death in non-Hodgkin lymphoma. J Am Coll Cardiol CardioOnc. 2024;6(1):133-135.
- Neilan TG, Quinaglia T, Onoue T, et al. Atorvastatin for anthracycline-associated cardiac dysfunction: the STOP-CA randomized clinical trial. JAMA. 2023;330(6):528-536.
