title: Statins and prostate cancer diagnosis and grade in a veterans population.
abstract: BACKGROUND
  Although prostate cancer is commonly diagnosed, few risk factors for high-grade prostate cancer are known and few prevention strategies exist. Statins have been proposed as a possible treatment to prevent prostate cancer.
  
  
  METHODS
  Using electronic and administrative files from the Veterans Affairs New England Healthcare System, we identified 55,875 men taking either a statin or antihypertensive medication. We used age- and multivariable-adjusted Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer incidence among patients taking statins (n = 41,078) compared with patients taking antihypertensive medications (n = 14,797). We performed similar analyses for all lipid parameters including total cholesterol examining each lipid parameter as a continuous variable and by quartiles. All statistical tests were two-sided.
  
  
  RESULTS
  Compared with men taking an antihypertensive medication, statin users were 31% less likely (HR = 0.69, 95% CI = 0.52 to 0.90) to be diagnosed with prostate cancer. Furthermore, statin users were 14% less likely (HR = 0.86, 95% CI = 0.62 to 1.20) to be diagnosed with low-grade prostate cancer and 60% less likely (HR = 0.40, 95% CI = 0.24 to 0.65) to be diagnosed with high-grade prostate cancer compared with antihypertensive medication users. Increased levels of total cholesterol were also associated with both total (HR = 1.02, 95% CI = 1.00 to 1.05) and high-grade (HR = 1.06, 95% CI = 1.02 to 1.10) prostate cancer incidence but not with low-grade prostate cancer incidence (HR = 1.01, 95% CI = 0.98 to 1.04).
  
  
  CONCLUSIONS
  Statin use is associated with statistically significantly reduced risk for total and high-grade prostate cancer, and increased levels of serum cholesterol are associated with higher risk for total and high-grade prostate cancer. These findings indicate that clinical trials of statins for prostate cancer prevention are warranted.
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA. wfarwell@partners.org
authors.forename: Wildon R
authors.initials: WR
authors.lastname: Farwell
authors.forename: Leonard W
authors.initials: LW
authors.lastname: D'Avolio
authors.forename: Richard E
authors.initials: RE
authors.lastname: Scranton
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Lawler
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016588:Anticarcinogenic Agents / Q000008:administration & dosage*; D000924:Anticholesteremic Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D000069059:Atorvastatin; D014408:Biomarkers, Tumor / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D015986:Confounding Factors, Epidemiologic; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D000077340:Fluvastatin; D006538:Heptanoic Acids / Q000008:administration & dosage; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D015994:Incidence; D007211:Indoles / Q000008:administration & dosage; D008055:Lipids / Q000097:blood; D008148:Lovastatin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009511:New England / Q000453:epidemiology; D017035:Pravastatin / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D011758:Pyrroles / Q000008:administration & dosage; D018570:Risk Assessment; D012720:Severity of Illness Index; D019821:Simvastatin / Q000008:administration & dosage; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D016588:Anticarcinogenic Agents; D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D014408:Biomarkers, Tumor; D005229:Fatty Acids, Monounsaturated; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D008055:Lipids; D011758:Pyrroles; D000077340:Fluvastatin; D002784:Cholesterol; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin