BACKGROUND: Cancer survivors may be at increased risk of cardiovascular diseases, but little is known about whether prescribing guidelines for the primary prevention of cardiovascular disease are adequately implemented in these patients.
AIM: To compare use of lipid-lowering drugs between cancer survivors and control patients with no previous cancer, specifically initiation and persistence on statins for primary prevention.
METHODS: We conducted a longitudinal population based open cohort study. Among individuals aged ≥40 during 2005-13 within the UK Clinical Practice Research Datalink primary care database, we identified cancer survivors ≥1y post-diagnosis and never-cancer controls. Using logistic regression, we compared these groups with respect to uptake of statins within one month of a high recorded cardiovascular risk score; and among statin initiators, we compared persistence on statins (time to statin cessation) using Cox modelling.
RESULTS: Among 4202 cancer survivors and 113035 controls with a record indicating a high cardiovascular risk score, 23.0% and 23.5% respectively initiated a statin within one month (adjusted odds ratio 0.98 [91.8-1.05], p=0.626). Among 12142 cancer survivors and 366280 controls who initiated a statin, cancer survivors appeared more likely to discontinue statin treatment than controls (adjusted HR 1.07 [1.01-1.12], p=0.02). This greater risk of discontinuing was only evident after the first year of therapy (p-interaction <0.001).
Conclusion: Although cardiovascular risk is thought to be higher in cancer survivors compared to the general population, cancer survivors were no more likely to receive statins, and more likely to cease therapy, than general population controls.