J Stroke.
2018 Jan;20(1):71-79. 10.5853/jos.2017.01802.
Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer
- Affiliations
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- 1Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. tneilan@mgh.harvard.edu
- 2Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- 3Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- 4Division of Cardiology, Department of Medicine, The Ohio State University, Columbus, OH, USA.
- 5Peter Munk Cardiac Centre, Toronto General Hospital, and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, ON, Canada.
- 6Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
- 7Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- 8Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- 9Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- 10Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- 11Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- KMID: 2424438
- DOI: http://doi.org/10.5853/jos.2017.01802
Abstract
- BACKGROUND AND PURPOSE
Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. Among broad populations, statins reduce CVEs; however, whether statins reduce CVEs after RT for HNCA is unclear. Therefore, we aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA.
METHODS
From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors.
RESULTS
The final cohort consisted of 1,011 patients (59±13 years, 30% female, 44% hypertension) with 288 (28%) on statins. Over a median follow-up of 3.4 years (interquartile range, 0.1 to 14) there were 102 CVEs (89 ischemic strokes and 13 TIAs) with 17 in statin users versus 85 in nonstatins users. In a multivariable model containing known predictors of CVE, statins were associated with a reduction in the combination of stroke and TIA (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2 to 0.8; P=0.01) and ischemic stroke alone (HR, 0.4; 95% CI, 0.2 to 0.8; P=0.01).
CONCLUSIONS
Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.
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