title: Statins and the risk of cancer after heart transplantation.
abstract: BACKGROUND
  Although newer immunosuppressive agents, such as mTOR (mammalian target of rapamycin) inhibitors, have lowered the occurrence of malignancies after transplantation, cancer is still a leading cause of death late after heart transplantation. Statins may have an impact on clinical outcomes beyond their lipid-lowering effects. The aim of the present study was to delineate whether statin therapy has an impact on cancer risk and total mortality after heart transplantation.
  
  
  RESULTS
  A total of 255 patients who underwent heart transplantation at the University Hospital Zurich between 1985 and 2007 and survived the first year were included in the present study. The primary outcome measure was the occurrence of any malignancy; the secondary end point was overall survival. During follow-up, a malignancy was diagnosed in 108 patients (42%). The cumulative incidence of tumors 8 years after transplantation was reduced in patients receiving a statin (34% versus 13%; 95% confidence interval, 0.25-0.43 versus 0.07-0.18; P<0.003). Statin use was associated with improved cancer-free and overall survival (both P<0.0001). A Cox regression model that analyzed the time to tumor formation with or without statin therapy, adjusted for age, male sex, type of cardiomyopathy, and immunosuppressive therapy (including switch to mTOR inhibitors or tacrolimus), demonstrated a superior survival in the statin group. Statins reduced the hazard of occurrence of any malignancy by 67% (hazard ratio, 0.33; 95% confidence interval, 0.21-0.51; P<0.0001).
  
  
  CONCLUSIONS
  Although it is not possible to adjust for all potential confounders because of the very long follow-up period, this registry suggests that statin use is associated with improved cancer-free and overall survival after cardiac transplantation. These data will need to be confirmed in a prospective trial.
authors: Cardiovascular Center Cardiology, Heart Failure/Transplantation Clinic, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. georg.froehlich@gmx.at
authors: Georg Marcus
authors: GM
authors: Fröhlich
authors: Kaspar
authors: K
authors: Rufibach
authors: Frank
authors: F
authors: Enseleit
authors: Mathias
authors: M
authors: Wolfrum
authors: Michelle
authors: M
authors: von Babo
authors: Michelle
authors: M
authors: Frank
authors: Reto
authors: R
authors: Berli
authors: Mathias
authors: M
authors: Hermann
authors: Johannes
authors: J
authors: Holzmeister
authors: Markus
authors: M
authors: Wilhelm
authors: Volkmar
authors: V
authors: Falk
authors: Georg
authors: G
authors: Noll
authors: Thomas F
authors: TF
authors: Lüscher
authors: Frank
authors: F
authors: Ruschitzka
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus