This is a fundamental issue for analysis because these two cancers may be associated with different risk factors (6, 7)

This is a fundamental issue for analysis because these two cancers may be associated with different risk factors (6, 7). CI 3.46C6.12) were independent factors significantly associated with esophageal cancer. Conclusions Use of atorvastatin 12 months may correlate with an 86% reduction of esophageal cancer risk. infection and use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) correlate with decreased risk of esophageal cancer (4C6). 3-Hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, known as statins, are commonly used to reduce the cholesterol level and Cilengitide to further decrease the risk of cardiovascular disease. Recently, two studies demonstrated that statins have the ability to inhibit proliferation and further increase apoptosis of esophageal adenocarcinoma cells (8, 9). A caseCcontrol study by Nguyen et al. in the Cilengitide United States showed that use of statins correlates with 45% reduction of esophageal cancer risk in patients with Barrett’s esophagus (95% confidence interval [CI] 0.36C0.86) (10). To date, there has been no study available on the association between the use of statins and esophageal cancer in Taiwan. With comprehensive understanding of esophageal cancer, new preventive strategies can be developed to help improve treatment outcomes and reduce related fatalities. Therefore, we conducted this caseCcontrol study using the National Health Insurance (NHI) program database in Taiwan to explore the following questions: (1) Is there an association between use of statins and esophageal cancer? (2) What are the effects of other co-morbidities and medications on the risk of esophageal cancer? Materials and methods Data sources This caseCcontrol study used data from the NHI program in Taiwan, the details of which can be found in previous studies (11C14). To ensure patient privacy, all personal identification data on files related to this study were replaced with surrogate identification numbers. This study was exempt from full review by the Institutional Review Board. Inclusion criteria For subjects, we selected those who were diagnosed recently with esophageal cancer (infection (ICD-9 codes 041.86), alcoholism (ICD-9 codes 303, 305.00, 305.01, 305.02, 305.03, V11.3, and A-code A215), and tobacco use (ICD-9 codes 305.1). Medication history of six commercially available statins before the index date, including simvastatin, lovastatin, pravastatin, fluvastatin, atorvastatin, and rosuvastatin, were included. The other medications included were as follows: non-statin lipid-lowering drugs, proton pump inhibitors, histamine-2 receptor antagonists, aspirin, other NSAIDs, and cyclooxygenase-2 inhibitors (COX-2 inhibitors). Statistical analysis We demonstrated the differences in demographic factors, co-morbidities, and medications between the esophageal cancer cases and the controls by the Chi-square test, 2,196) (%)(%)infection10 Cilengitide (0.46)3 (0.55)0.78Medications?Use of statins238 (10.8)49 (8.93)0.19?Use of non-statin, lipid-lowering drugs209 (9.52)58 (10.6)0.46?Use of proton pump Cilengitide inhibitors284 12.9)262 (47.7) 0.0001?Use of histamine-2 receptor antagonists1139 (51.9)391 (71.2) 0.0001?Use of aspirin715 (32.6)187 (34.1)0.50?Use of other NSAIDs2021 (92.0)526 (95.8)0.002?Use of COX-2 inhibitors534 (24.3)157 (28.6)0.04 Open in a separate window Data are presented as the number of subjects in each group, with percentages given in SPN parentheses. Chi-square test * as a reference500/2,4581.00 (reference)1.00 (reference)Atorvastatin?All19/1330.65 (0.40C1.07)0.52 (0.30C0.92)? 6 months10/680.68 (0.34C1.33)0.57 (0.27C1.21)?6C11 months6/201.68 (0.64C4.39)1.86 (0.66C5.24)? 12 months3/450.28 (0.09C0.91)0.14 (0.04C0.56)Simvastatin?All20/1030.94 (0.57C1.55)0.79 (0.44C1.40)? 6 months18/551.91 (1.08C3.38)1.67 (0.86C3.25)?6C11 months0/20CC? 12 months2/280.30 (0.07C1.27)0.21 (0.04C1.01)Lovastatin?All13/840.72 (0.39C1.31)0.60 (0.30C1.18)? 6 months8/570.64 (0.30C1.35)0.50 (0.21C1.16)?6C11 months3/141.07 (0.30C3.84)1.29 (0.34C5.00)? 12 months2/130.71 (0.16C3.22)0.48 (0.08C2.95)Fluvastatin?All9/460.95 (0.46C1.99)0.81 (0.35C1.86)? 6 months5/300.78 (0.30C2.06)0.65 (0.22C1.92)?6C11 months1/70.65 (0.08C5.43)0.58 (0.05C6.82)? 12 months3/91.96 (0.49C7.86)1.68 (0.33C8.49)Pravastatin?All4/290.63 (0.22C1.81)0.50 (0.16C1.61)? 6 months3/220.62 (0.18C2.10)0.57 (0.15C2.19)?6C11 months0/3CC? 12 months1/41.31 (0.14C12.6)1.26 (0.12C13.8)Rosuvastatin?All4/280.65 (0.23C1.89)0.37 (0.11C1.21)? 6 months2/170.52 (0.12C2.29)0.25 (0.05C1.30)?6C11 months1/31.96(0.18C21.6)1.33 (0.11C16.3)? 12 months1/80.56(0.07C4.56)0.35 (0.04C3.61) Open in a separate window ?Adjusted for age, sex, esophageal diseases, alcoholism, statins, proton pump inhibitors, histamine-2 receptor antagonists, other NSAIDs, and COX-2 inhibitors. Discussion A growing body of epidemiologic evidence has shown that use of statins correlates with risk reduction of some digestive cancers, including those of stomach, colonCrectum, liver, and pancreas (15C18). To the best of our knowledge, the association between the use of statins and esophageal cancer is still under investigation. In this study, we found patients using statins had an overall 34% risk reduction of esophageal cancer, when compared with the group not using statins. In sub-analysis, atorvastatin could reduce 86% risk of esophageal cancer when used for 12 months. These results are consistent with a previous study by Nguyen et al. (10), which suggested that use of statins for more than 12 months can correlate with 48% risk reduction of esophageal cancer in patients with Barrett’s esophagus (95% CI 0.30C0.91) (10). Although the mechanism behind the correlation of the use of statins with decreased risk of esophageal cancer.