Use of statin medications and risk of esophageal adenocarcinoma in persons with Barrett's esophagus
Menée auprès de 411 participants atteints d'un endobrachyœsophage, cette étude de cohorte prospective évalue l'association entre la prise de statines et le risque d'adénocarcinome de l'œsophage
Background: Persons with Barrett's esophagus experience increased incidence of esophageal adenocarcinoma (EA) and may benefit from use of preventives. Studies suggest that statin medications may have chemopreventive properties; we therefore assessed the association between statin use and progression to EA. Methods: In a prospective cohort of 411 persons with Barrett's, Cox regression was used to calculate hazard ratios (HR) between statin use and EA risk, accounting for variation in use over follow-up and adjusting for age, sex, and smoking. Results: The HR (95% CI) for statin use among all participants was 0.68 (0.30-1.54) after further adjustment for non-steroidal anti-inflammatory drug (NSAID) use. Among persons with high-grade dysplasia (HGD) detected as of baseline, the HRs for statin use were 0.31 (0.11-0.86) and 0.41 (0.13-1.26) before and after adding NSAIDs to the model, respectively. In this subset with HGD, the HR for joint statin and NSAID use was 0.19 (0.06-0.64). This HR is lower than that observed for use of statins only (HR: 0.40; 0.08-1.94) and for NSAIDs only (HR: 0.45; 0.17-1.19). Conclusions: While the reduced risk of EA observed among statin users may be explained by chance, the point estimates are similar in magnitude to those previously reported for NSAID use in this cohort, and are unlikely confounded by known risk factors. Among those with HGD, concurrent use of statins and NSAIDs may be more protective than taking either drug individually. Impact: Continued study of this issue is warranted, as there is need to identify effective prevention strategies among high-risk groups.