title: The Association of Dyslipidemia With Chronic Lymphocytic Leukemia: A Population-Based Study.
abstract: Metabolic syndrome (MetS) is a risk factor for development of cancer. Because aberrant lipid metabolism is a pathogenic feature of chronic lymphocytic leukemia (CLL), our objective was to determine if CLL patients have a higher prevalence of MetS preceding diagnosis and to determine the impact of lipid-lowering medications on survival.
  
  
  
  We conducted a population-based case-control study in Ontario, Canada, using administrative databases of adults age 66 years and older to compare the prevalence of MetS preceding CLL with age- and sex-matched control subjects. Logistic regression was used to study the association between MetS and its components to CLL. The Kaplan-Meier method and Cox Regression were used to investigate survival. All statistical tests were two-sided.
  
  
  
  We identified 2124 persons with CLL and 7935 control subjects from January 1, 2000, to December 31, 2005, with follow-up until March 31, 2014, three years from the date of last contact with the health care system, or death. The mean age was 75.6 years, 20.2% had diabetes, 35.8% had hypertension, and 17.6% had dyslipidemia. In multivariable analysis, dyslipidemia (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.44, P < .001) and hypertension (OR = 1.12, 95% CI = 1.01 to 1.25, P = .03) were associated with the development of CLL, whereas MetS and diabetes were not. Lipid-lowering medication was associated with a statistically significant improved survival in patients with CLL (HR = 0.53, 95% CI = 0.47 to 0.61, P < .001).
  
  
  
  We demonstrate a higher prevalence of dyslipidemia preceding a diagnosis of CLL compared with control subjects, supporting preclinical data. Lipid-lowering medications appear to confer a survival advantage in CLL. Prospective studies are needed to confirm these results and test their potential as therapeutic applications.
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: Lee
authors.initials: L
authors.lastname: Mozessohn
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: Craig
authors.initials: C
authors.lastname: Earle
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: David
authors.initials: D
authors.lastname: Spaner
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: Stephanie Y
authors.initials: SY
authors.lastname: Cheng
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: Matthew
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Affiliations of authors: Division of Hematology/Medical Oncology (LM, CCE, DS, RB) and Division of Molecular and Cellular Biology (DS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (CCE, SYC, MK); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (CCE).
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors