Abstract 3009: Lipid-lowering drug use and risk of fatal prostate cancer in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mondul Alison M. , Joshu Corinne E. , Barber John , Prizment Anna , Bahvsar Nrupen , Coresh Josef , Selvin Elizabeth , Folsom Aaron , Platz Elizabeth A. 
Published: July 2017

Abstract
Background: Studies show that lipid-lowering medications, particularly statins, may be protective for more aggressive prostate cancer. Lethal prostate cancer is often considered an optimal outcome in epidemiologic studies when the aim is to identify modifiable risk factors with the potential to reduce morbidity and mortality from this disease, yet this outcome remains understudied. Further, lipid drug use and prostate cancer risk is understudied in black men, whose risk of fatal prostate cancer is 2-3 times higher than that of white men. Thus, we studied lipid medication use and fatal prostate cancer risk in the ARIC Study, which includes ~25% black participants.
Methods: The ARIC Study is a prospective cohort that included 15,792 participants (7,082 men) recruited from four US communities. We conducted a prospective cohort analysis of 6,547 men who attended visit 2 (1990-1992, the start of the statin era) and were followed for cancer death through 12/31/2012. Death from prostate cancer (n=90) as the underlying cause was obtained from death certificates supplemented with medical records. Updated information on medication use was collected throughout the study follow-up during study visits and annual telephone calls. Lipid medication use was modeled as a time-dependent variable in two ways: 1) current use (yes/no), and 2) duration of use (&lt;10, ≥10 years). Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of prostate cancer death overall and by race. All models were adjusted for age (years), race, and study center. Additional models were further adjusted for height, BMI, smoking, diabetes, and education.
Results: The prevalence of lipid medication use was 17% by visit 4, partway into the statin drug era, and 76% of those medications were statins. After adjustment for age, race, and study center, men who used lipid medications were statistically significantly less likely to die from prostate cancer than men who did not use lipid medications (HR=0.56, 95% CI=0.33-0.95). This finding was slightly attenuated after further mutlivariable adjustment (HR=0.62, 0.36-1.08). The statistically significant inverse association appeared to be restricted to men who used lipid medications for ≥10 years (vs. never use: HR=0.39, 95% CI=0.19-0.82, p-trend=0.02). Lipid medication use was inversely associated with a reduced risk of prostate cancer death in both white and black men. Conclusions: Use of lipid medications was associated with a lower risk of fatal prostate cancer in both black and white men. Whether the fact that black men are less likely to receive/take lipid medications could partly explain the black-white disparity in prostate cancer in the US requires further study.
Support: NHLBI contracts, NCI grant, NPCR
Citation Format: Alison M. Mondul, Corinne E. Joshu, John Barber, Anna Prizment, Nrupen Bahvsar, Josef Coresh, Elizabeth Selvin, Aaron Folsom, Elizabeth A. Platz. Lipid-lowering drug use and risk of fatal prostate cancer in the Atherosclerosis Risk in Communities (ARIC) Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3009. doi:10.1158/1538-7445.AM2017-3009