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A Nested Case-Control Study

Lucie Blais, PhD; Alain Desgagné, MSc; Jacques LeLorier, MD, PhD

Arch Intern Med. 2000;160:2363-2368.

Background  During the past 15 years there has been an exponential increase in the number of prescriptions for lipid-lowering drugs. Uncertainties remain about the long-term impact of these medications on cancer, which is particularly bothersome given that the duration of these treatments may extend for several decades.

Objective  To explore the association between 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and cancer incidence.

Methods  Using the administrative health databases of the Régie de l'Assurance-Maladie du Québec we performed a nested case-control study. We selected a cohort of 6721 beneficiaries of the health care plan of Quebec who were free of cancer for at least 1 year at cohort entry, 65 years and older, and treated with lipid-modifying agents. Cohort members were selected between 1988 and 1994 and were followed up for a median period of 2.7 years. From the cohort, 542 cases of first malignant neoplasm were identified, and 5420 controls were randomly selected. Users of HMG-CoA reductase inhibitors were compared with users of bile acid–binding resins as to their risk of cancer. Specific cancer sites were also considered.

Results  Users of HMG-CoA reductase inhibitors were found to be 28% less likely than users of bile acid–binding resins to be diagnosed as having any cancer (rate ratio, 0.72; 95% confidence interval, 0.57-0.92). All specific cancer sites under study were found to be not or inversely associated with the use of HMG-CoA reductase inhibitors.

Conclusion  The results of our study provide some degree of reassurance about the safety of HMG-CoA reductase inhibitors.

From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Unité de Pharmaco-Économie et de Pharmaco-Épidémiologie, Montreal, Quebec.

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