Statin use and risk of basal cell carcinoma - 07/08/11

Doi : 10.1016/j.jaad.2009.02.011

Maryam M. Asgari, MD, MPH ^a,^b,^⁎ , Jean Tang, MD, PhD ^b,^e, Ervin H. Epstein, MD ^e, Mary-Margaret Chren, MD ^b,^d, E. Margaret Warton, MPH ^a, Charles P. Quesenberry, PhD ^a, Alan S. Go, MD ^a,^c, Gary D. Friedman, MD, MS ^a,^f
^a Division of Research, Kaiser Permanente Northern California, Oakland, California
^b Department of Dermatology, University of California at San Francisco, San Francisco, California
^c Department of Epidemiology, Biostatistics, and Medicine, University of California at San Francisco, San Francisco, California
^d Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
^e Children’s Hospital Oakland Research Institute, Oakland, California
^f Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California

Reprint requests: Maryam M. Asgari, MD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612.

Abstract

Objective

We examined the association between statin use and basal cell carcinoma (BCC) risk.

Methods

We identified all members of a large integrated health care delivery system with a diagnosis of a histologically proven BCC in 1997. Subsequent BCCs were identified through 2006 from health plan electronic pathology records. Longitudinal exposure to statins and other lipid-lowering agents was determined from automated pharmacy records. We used extended Cox regression to examine the independent association between receipt of statin therapy (ever vs never, cumulative duration) and risk of subsequent BCC. To minimize confounding by indication, we conducted sensitivity analyses in the subset of individuals considered eligible for lipid-lowering therapy based on national guidelines.

Results

Among 12,123 members given a diagnosis of BCC who had no prior statin exposure, 6381 developed a subsequent BCC during follow-up. Neither “ever use of statins” (adjusted hazard ratio 1.02, 95% confidence interval: 0.92-1.12) or cumulative duration of statin (adjusted hazard ratio 1.02/year, 95% confidence interval: 0.99-1.11) was associated with subsequent BCC after adjustment for age, sex, and health care use. Risk estimates did not change appreciably when the analysis was limited to the subset of individuals who met eligibility criteria for initiating statin therapy. There was also no significant association between use of non-statin antilipemics and subsequent BCC (adjusted hazard ratio 1.10, 95% confidence interval: 0.76-1.58).

Limitations

No information was available for BCC risk factors, such as sun sensitivity and sun exposure.

Conclusions

Among a large cohort of individuals with BCC, statin therapy was not significantly associated with risk of subsequent BCC.

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Key words : basal cell carcinoma, pharmacoepidemiology, skin cancer, statin

Abbreviations used : aHR, BCC, CI, KPNC, UV

Plan

Methods

Study population

Exposure to statin therapy

Follow-up and outcome

Covariates

Statistical analysis

Results

Cohort characteristics

Statin therapy and subsequent BCC risk

Cumulative statin exposure and subsequent BCC

Statin use and BCC risk in treatment-eligible patients

Other lipid-lowering agents and subsequent BCC

Discussion

Supported in part by the National Institute of Arthritis Musculoskeletal and Skin Diseases (K23 AR 051037 to Dr Asgari, K24 AR 052667 to Dr Chren) and by the National Cancer Institute (R01 CA 098838 to Dr Friedman).

Disclosure: Dr Friedman served on an advisory committee for Roche Pharmaceuticals in June 2008. He has consulted for law firms serving the plaintiffs regarding litigation concerning celecoxib and serving Ortho-McNeil-Janssen Pharmaceuticals regarding litigation concerning Ortho-Evra. None of these associations influenced his work on this article. Drs Asgari, Tang, Epstein, Chren, Quesenberry, and Go, and Ms Warton have no conflicts of interest to declare.