Low LDL cholesterol, albuminuria, and statins for the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry.
OBJECTIVE
LDL cholesterol <2.80 mmol/l was associated with increased cancer risk in type 2 diabetes. We explored the 1) interaction between low LDL cholesterol and albuminuria and 2) interaction between copresence of these two risk factors and statin use for cancer in type 2 diabetes.


METHODS
We analyzed prospective data for 3,793 Chinese type 2 diabetic patients who remained naive for statin treatment and 1,483 patients in whom statin treatment was initiated during a median follow-up period of 5.24 years. All patients were free of cancer at baseline. Biological interactions were estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). RERI > 0, AP > 0, or S > 1 indicates biological interaction.


RESULTS
In 3,793 statin-naive type 2 diabetic patients, copresence of low LDL cholesterol and albuminuria increased cancer risk by 2.8-fold (hazard ratio 2.77 [95% CI 1.78-4.31]) with significant biological interactions (RERI 1.05 [0.04-2.06]; AP 0.38 [0.09-0.66]). In the whole cohort of 5,276 type 2 diabetic patients, there was interaction between nonuse of statins and copresence of low LDL cholesterol and albuminuria with increased cancer risk (RERI 2.87 [0.64-5.09] and AP 0.60 [0.29-0.90]). Statin nonusers with LDL cholesterol <2.80 mmol/l and albumunuria had a 4.9-fold risk of cancer compared with statin users with or without both risk factors.


CONCLUSIONS
In type 2 diabetes, there was interaction between low LDL cholesterol and albuminuria with increased cancer risks. The latter was attenuated in the presence of statin treatment.
Yang
Xilin
X
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China. yang.xilin@cuhk.edu.hk
So
Wing Yee
WY
Ma
Ronald C W
RC
Ko
Gary T C
GT
Kong
Alice P S
AP
Zhao
Hailu
H
Luk
Andrea O Y
AO
Lam
Christopher W K
CW
Ho
Chung Shun
CS
Tong
Peter C Y
PC
Chan
Juliana C N
JC
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006723:Hong Kong; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D012042:Registries; D012307:Risk Factors
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors