Low LDL Cholesterol, Albuminuria, and Statins for the Risk of Cancer in Type 2 Diabetes
The Hong Kong Diabetes Registry
- Xilin Yang, PHD1,
- Wing Yee So, MD, FRCP1,
- Ronald C.W. Ma, MBBCHIR, MRCP1,
- Gary T.C. Ko, MD, FRCP2,
- Alice P.S. Kong, MBCHB, FRCP1,3,
- Hailu Zhao, PHD1,
- Andrea O.Y. Luk, MBCHB, MRCP1,
- Christopher W.K. Lam, PHD4,
- Chung Shun Ho, PHD4,
- Peter C.Y. Tong, PHD, FRCP1,2 and
- Juliana C.N. Chan, MD, FRCP1,2,3
- 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China;
- 2Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China;
- 3Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China;
- 4Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Corresponding author: Xilin Yang, yang.xilin{at}cuhk.edu.hk.
Abstract
OBJECTIVE LDL cholesterol <2.80 mmol/l was associated with increased cancer risk in type 2 diabetes. We explored the 1) interaction between low LDL cholesterol and albuminuria and 2) interaction between copresence of these two risk factors and statin use for cancer in type 2 diabetes.
RESEARCH DESIGN AND METHODS We analyzed prospective data for 3,793 Chinese type 2 diabetic patients who remained naive for statin treatment and 1,483 patients in whom statin treatment was initiated during a median follow-up period of 5.24 years. All patients were free of cancer at baseline. Biological interactions were estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). RERI > 0, AP > 0, or S > 1 indicates biological interaction.
RESULTS In 3,793 statin-naive type 2 diabetic patients, copresence of low LDL cholesterol and albuminuria increased cancer risk by 2.8-fold (hazard ratio 2.77 [95% CI 1.78–4.31]) with significant biological interactions (RERI 1.05 [0.04–2.06]; AP 0.38 [0.09–0.66]). In the whole cohort of 5,276 type 2 diabetic patients, there was interaction between nonuse of statins and copresence of low LDL cholesterol and albuminuria with increased cancer risk (RERI 2.87 [0.64–5.09] and AP 0.60 [0.29–0.90]). Statin nonusers with LDL cholesterol <2.80 mmol/l and albumunuria had a 4.9-fold risk of cancer compared with statin users with or without both risk factors.
CONCLUSIONS In type 2 diabetes, there was interaction between low LDL cholesterol and albuminuria with increased cancer risks. The latter was attenuated in the presence of statin treatment.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received April 15, 2009.
- Accepted July 1, 2009.
- © 2009 by the American Diabetes Association.
