by Karolinska Institutet

Cumulative incidence of incident colorectal cancer (CRC), CRC-related mortality, and all-cause mortality among statin-users and non-statin users. The P values for the three comparisons were 0.019, 0.0040, and <0.0001, respectively, and were derived from the stratified subdistribution hazard model. Credit: eClinicalMedicine (2023). DOI: 10.1016/j.eclinm.2023.102182

Cholesterol-lowering statins might protect patients with ulcerative colitis from developing and dying from colorectal cancer. Statin treatment was also associated with a lower risk of death regardless of cause in patients with ulcerative colitis or Crohn's disease. This is according to a study by researchers at Karolinska Institutet published in eClinicalMedicine.

"Even though more studies are needed to confirm our results, our study suggests that statins can prevent colorectal cancer in patients with inflammatory bowel disease (IBD), which is a high-risk group for this kind of cancer," says the study's first author Jiangwei Sun, researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.

The observational study conducted by Dr. Sun and his colleagues compared more than 10,500 IBD patients from around the country, of whom half were statin users; the other half of the group, who were matched with the first, were not. After a follow-up period of, on average, 5.6 years, 70 of the statin group and 90 of the non-statin group had been diagnosed with colorectal cancer.

The effect increased over time

The protective effect was directly proportional to the length of time the patient had been on statins and could be demonstrated after two years' treatment.

There were also fewer deaths from colorectal cancer in the statin group (20) than in the non-statin group (37) during the study period, and deaths regardless of cause (529 versus 719).

The study shows that some 200 IBD patients need to be treated with statins to avoid one case of colorectal cancer or death from the cancer within ten years of treatment onset. The protective effect was only statistically valid for patients with ulcerative colitis.

"We think this is because the study contained fewer patients with Crohn's disease," explains Dr. Sun. "More and larger studies compiling data from patient populations in many countries will probably be needed to achieve statistical significance for Crohn's disease."

Significantly fewer deaths

To avoid death regardless of cause during the same ten-year period, the number of treated patients dropped to 20, on account of how statins also protect against more common conditions, such as cardiovascular disease. Statins were linked to fewer deaths in both ulcerative colitis and Crohn's disease patients.

The study was based on the ESPRESSO-cohort, which is run by its initiative-taker Jonas F Ludvigsson, pediatrician at Örebro University Hospital and professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and the study's last author.

"In that we can combine tissue data from patients with colorectal cancer with data from Swedish health registries, we're uniquely placed to study the long-term effects of drugs for IBD," he says. "Our hope is that these studies will improve the care of IBD patients."

The most solid evidence so far

According to the researchers, the new results provide the most solid evidence so far that statins could be an effective prophylactic for colorectal cancer among people with IBD. However, more knowledge must be gathered before the treatment can be recommended in general guidelines.

"More studies are needed to ascertain if there is a causal relationship, at what point of the pathological process statins should be administered, what a reasonable dose would be and how long treatment needs to last if it's to be of benefit," says Dr. Sun.

More information: Jiangwei Sun et al, Statin use and risk of colorectal cancer in patients with inflammatory bowel disease, eClinicalMedicine (2023). DOI: 10.1016/j.eclinm.2023.102182

Journal information: EClinicalMedicine 

Provided by Karolinska Institutet