AJG: 长期使用他汀类药物与总胆固醇水平和结直肠癌发生风险之间的关系

2022-01-20 MedSci原创 MedSci原创

他汀类药物,即3-羟基-3甲基戊二酰辅酶A(HMG-CoA)还原酶抑制药,不仅能强效地降低总胆固醇和低密度脂蛋白,而且能一定程度上降低三酰甘油,还能升高高密度脂蛋白。

在美国,他汀类药物是最常用的降胆固醇药物,在过去的几十年里,他汀类药物是一种常用于治疗高胆固醇血症和降低心脏死亡率和发病率的降脂药物。作为大肠癌(CRC)的潜在化学预防药物,他汀类药物也得到了深入的研究。但目前的流行病学和临床证据表明,在CRC初级预防中,长期使用他汀类药物的潜力仍然很有限。我们已知,阿司匹林对CRC的化学预防作用需要大约10年或更长时间才能有效。因此,本项研究对长期使用他汀类药物与总胆固醇水平和CRC风险之间的关系进行了前瞻性研究。

研究人员对护士健康研究和卫生专业人员随访研究队列中的合格参与者(100,300 名女性和 47,991 名男性)进行了长达 24 年的随访。然后使用Cox 比例风险模型用于估计风险比和 95% 置信区间。

本项研究发现在整个随访期间记录了 2,924 起CRC 病例,研究人员发现较长的他汀类药物使用时间与较高的结肠癌风险相关(1-5年的HR为1.09; 95%[CI]: 0.95-1.25;6-10 年的HR为1.16、 95%[CI]:0.99-1.36; 11-15 年的HR:1.08,95%[CI]: 0.81-1.44;>15年的HR为1.85,95%[CI]:1.30-2.61; P= 0.004)。风险升高是由近端结肠癌驱动的(1-5 年的HR为 1.16,95%[CI]:0.98-1.38;6-10 年HR为1.19,95%[CI]:0.98-1.45;11-15 年HR为1.25,95%[CI]:0.89-1.74;>15年2.17,95%[CI]:1.46-3.24;P= 0.001)而不是远端结肠癌。在高胆固醇血症或从未接受过筛查的参与者的分析中,研究人员发现总胆固醇水平与 CRC 风险无关。

图:他汀类药物与CRC的关系

本项研究结果不支持他汀类药物在 CRC 化学预防中的益处或总胆固醇水平与 CRC 风险之间的任何关联。相反,长期使用他汀类药物可能会增加结肠癌风险(由近端结肠癌驱动)。

原始出处:

Zhang, Yin. Et al. Long-Term Statin Use, Total Cholesterol Level, and Risk of Colorectal Cancer: A Prospective Cohort Study. The American Journal of Gastroenterology.2022.

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    2022-03-12 minzju5052
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