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Associations among statins, preventive care, and prostate cancer mortality.

Abstract：

BACKGROUND:Increasing evidence indicates an association between statins and reduced prostate cancer-specific mortality (PCSM). However, significant bias may exist in these studies. One particularly challenging bias to assess is the healthy user effect, which may be quantified by screening patterns. We aimed to evaluate the association between statin use, screening, and PCSM in a dataset with detailed longitudinal information. METHODS:We used the Veterans Affairs Informatics and Computing Infrastructure to assemble a cohort of patients diagnosed with prostate cancer (PC) between 2000 and 2015. We collected patient-level demographic, comorbidity, and tumor data. We also assessed markers of preventive care utilization including cholesterol and prostate specific antigen (PSA) screening rates. Patients were considered prediagnosis statin users if they had at least one prescription one or more years prior to PC diagnosis. We evaluated PCSM using hierarchical Fine-Gray regression models and all-cause mortality (ACM) using a cox regression model. RESULTS:The final cohort contained 68,432 men including 40,772 (59.6%) prediagnosis statin users and 27,660 (40.4%) nonusers. Prediagnosis statin users had higher screening rates than nonusers for cholesterol (90 vs. 69%, p < 0.001) and PSA (76 vs. 67%, p < 0.001). In the model which excluded screening, prediagnosis statin users had improved PCSM (SHR 0.90, 95% CI 0.84-0.97; p = 0.004) and ACM (HR 0.96, 95% CI 0.93-0.99; p = 0.02). However, after including cholesterol and PSA screening rates, prediagnosis statin users and nonusers showed no differences in PCSM (SHR 0.98, 95% CI 0.91-1.06; p = 0.59) or ACM (HR 1.02, 95% CI 0.98-1.05; p = 0.25). CONCLUSION:We found that statin users tend to have more screening than nonusers. When we considered screening utilization, we observed no relationship between statin use before a prostate cancer diagnosis and prostate cancer mortality.

journal_name

Prostate Cancer Prostatic Dis

journal_title

Prostate cancer and prostatic diseases

authors

Kumar A,Riviere P,Luterstein E,Nalawade V,Vitzthum L,Sarkar RR,Bryant AK,Einck JP,Mundt AJ,Murphy JD,Rose BS

doi

10.1038/s41391-020-0207-5

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

475-485

issue

eissn

1365-7852

issn

1476-5608

pii

10.1038/s41391-020-0207-5

journal_volume

pub_type

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Associations among statins, preventive care, and prostate cancer mortality.