Statins and risk of cardiovascular disease: emulating a primary prevention trial in breast cancer survivors
Abstract
BACKGROUND: Limited evidence is available from randomized trials to guide clinical decision making for cardiovascular disease (CVD) prevention with statins among women with breast cancer. We leveraged real-world data to estimate the effect of statin therapy vs usual care on the 5-year risk of CVD among breast cancer survivors. METHODS: We sequentially emulated target trials using the National Cancer Institute-Kaiser Permanente Breast Cancer Survivors Cohort. Women aged 40-84 years, diagnosed with stages 0-III breast cancer from 1993 to 2022, without CVD, no statins in the past 6 months, and low-density lipoprotein cholesterol from 100 to 160 mg/dL were included. The outcome was CVD (ischemic heart disease, stroke, and cardiomyopathy/heart failure). We compared statin therapy to usual care (no statins unless indicated) in intention-to-treat and per-protocol analyses. RESULTS: Statin initiators were more likely to be older with a higher prevalence of cardiovascular comorbidities. In the intention-to-treat analysis, the 5-year risk difference was 0.3% (95% CI = -0.9 to 1.5), and risk ratio was 1.04 (95% CI = 0.86 to 1.25) for statin vs usual care. At 5 years, the proportion adherent to their initial strategy was 48% for statin and 24% for usual care. In the per-protocol analysis, the risk difference was -0.9% (95% CI = -2.9 to 2.2) and the risk ratio was 0.85 (95% CI = 0.51 to 1.36) for statin vs usual care. CONCLUSIONS: Our findings suggest that statin therapy may reduce the risk of CVD for breast cancer survivors, but the estimates are too imprecise for specific recommendations. Future research is needed to understand reasons for statin discontinuation, and opportunities to encourage adherence in this high-risk population.
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BibTeX
@article{russo2026statins,
title = {{Statins and risk of cardiovascular disease: emulating a primary prevention trial in breast cancer survivors}},
author = {Rienna G Russo and Miguel A Hernán and Issa J Dahabreh and Eric B Rimm and Lene H S Veiga and Amber N Hurson and Rochelle E Curtis and Ruth M Pfeiffer and Quiera S Booker and Macy E Corley and Paloma R Mitra and A Blythe Ryerson and Stacey Honda and Larissa White and Heather Spencer Feigelson and Erin J Aiello Bowles and Véronique L Roger and Cody Ramin and Ana Barac and Gretchen L Gierach and Goodarz Danaei and Jacqueline B Vo},
journal = {JNCI Journal of the National Cancer Institute},
year = {2026},
month = may,
doi = {10.1093/jnci/djag158},
url = {https://doi.org/10.1093/jnci/djag158},
note = {Public domain},
}
RIS
TY - JOUR
TI - Statins and risk of cardiovascular disease: emulating a primary prevention trial in breast cancer survivors
AU - Rienna G Russo
AU - Miguel A Hernán
AU - Issa J Dahabreh
AU - Eric B Rimm
AU - Lene H S Veiga
AU - Amber N Hurson
AU - Rochelle E Curtis
AU - Ruth M Pfeiffer
AU - Quiera S Booker
AU - Macy E Corley
AU - Paloma R Mitra
AU - A Blythe Ryerson
AU - Stacey Honda
AU - Larissa White
AU - Heather Spencer Feigelson
AU - Erin J Aiello Bowles
AU - Véronique L Roger
AU - Cody Ramin
AU - Ana Barac
AU - Gretchen L Gierach
AU - Goodarz Danaei
AU - Jacqueline B Vo
PY - 2026
DA - 2026/05/29
JO - JNCI Journal of the National Cancer Institute
DO - 10.1093/jnci/djag158
UR - https://doi.org/10.1093/jnci/djag158
AB - BACKGROUND: Limited evidence is available from randomized trials to guide clinical decision making for cardiovascular disease (CVD) prevention with statins among women with breast cancer. We leveraged real-world data to estimate the effect of statin therapy vs usual care on the 5-year risk of CVD among breast cancer survivors. METHODS: We sequentially emulated target trials using the National Cancer Institute-Kaiser Permanente Breast Cancer Survivors Cohort. Women aged 40-84 years, diagnosed with stages 0-III breast cancer from 1993 to 2022, without CVD, no statins in the past 6 months, and low-density lipoprotein cholesterol from 100 to 160 mg/dL were included. The outcome was CVD (ischemic heart disease, stroke, and cardiomyopathy/heart failure). We compared statin therapy to usual care (no statins unless indicated) in intention-to-treat and per-protocol analyses. RESULTS: Statin initiators were more likely to be older with a higher prevalence of cardiovascular comorbidities. In the intention-to-treat analysis, the 5-year risk difference was 0.3% (95% CI = -0.9 to 1.5), and risk ratio was 1.04 (95% CI = 0.86 to 1.25) for statin vs usual care. At 5 years, the proportion adherent to their initial strategy was 48% for statin and 24% for usual care. In the per-protocol analysis, the risk difference was -0.9% (95% CI = -2.9 to 2.2) and the risk ratio was 0.85 (95% CI = 0.51 to 1.36) for statin vs usual care. CONCLUSIONS: Our findings suggest that statin therapy may reduce the risk of CVD for breast cancer survivors, but the estimates are too imprecise for specific recommendations. Future research is needed to understand reasons for statin discontinuation, and opportunities to encourage adherence in this high-risk population.
SN - 0027-8874
SN - 1460-2105
ER -