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Rates of underuse of statins among cancer survivors versus controls: NHANES 2011–2016

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Abstract

Purpose

Cardiovascular disease (CVD) is a major non-cancer cause of mortality among cancer survivors, and statin therapy is the mainstay of cardiovascular risk management. However, little is known about adherence to statin therapy relative to current guidelines for the management of cholesterol among cancer survivors. We investigated the prevalence of statin-eligible but untreated individuals among cancer survivors and factors associated with underuse of statins.

Methods

We used US National Health and Nutrition Examination Survey data (2011–2016) and identified 706 cancer survivors and matched controls (1:2) by age and sex. We identified participants who met the American College of Cardiology/American Heart Association (2018) guidelines but were not currently in treatment. We estimated the proportion of patients who were statin-eligible but untreated and performed multivariable logistic regression analysis to identify the factors associated with underuse of statins.

Results

The mean age of the total sample was 62.2 years (standard deviation, 9.1). Among the total participants, 37.5% of cancer survivors and 37.2% of controls were statin-eligible but untreated. The crude statin-eligible untreated proportion was 41.2% among cancer survivors who had received a cancer diagnosis within 3 years and 40.3% among long-term survivors of 10 years or more. In multivariate analysis, old age, male sex, lack of a usual source of care, current smoking, and low household income were significantly associated with statin-eligible untreated status.

Conclusions and Implications for Cancer Survivors

More than one-third of cancer survivors were statin-eligible but untreated under current guidelines. There is room for improvement to reduce the burden of non-cancer mortality by managing traditional cardiovascular risk factors.

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Fig. 1: The treatment status of dyslipidemia in cancer survivors compared to matched controls.

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Author information

Author notes

  1. Dong Wook Shin and Juhee Cho contributed equally to this work.

Authors and Affiliations

  1. Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Su-Min Jeong

  2. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Su-Min Jeong

  3. Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, Republic of Korea

    Dong Wook Shin

  4. Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Dong Wook Shin & Juhee Cho

  5. Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Juhee Cho

  6. Cancer Education Center, Samsung Comprehensive Cancer Center, Seoul, Republic of Korea

    Juhee Cho

  7. Departments of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Juhee Cho

Authors
  1. Su-Min Jeong
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  2. Dong Wook Shin
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  3. Juhee Cho
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Contributions

DW Shin had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of data analysis. Study concept and design: SM Jeong, DW Shin, and J Cho. Acquisition of the data: SM Jeong. Analysis and interpretation of the data: SM Jeong and DW Shin. Drafting of the manuscript: SM Jeong and DW Shin. Critical revision of the manuscript: SM Jeong, DW Shin, and J Cho. Statistical analysis: SM Jeong and DW Shin.

Corresponding authors

Correspondence to Dong Wook Shin or Juhee Cho.

Ethics declarations

All participants provided written informed consent, and the NHANES protocol was approved by the Institutional Review Board of the National Center for Health Statistics.

Conflict of interest

The authors declare that they have no conflict of interest.

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Jeong, SM., Shin, D.W. & Cho, J. Rates of underuse of statins among cancer survivors versus controls: NHANES 2011–2016. J Cancer Surviv 14, 434–443 (2020). https://doi.org/10.1007/s11764-020-00865-z

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  • DOI: https://doi.org/10.1007/s11764-020-00865-z

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