除了对心血管系统的保护作用外，他汀类药物可能通过潜在的抗炎益处减少乳腺癌复发的风险。考虑到亚洲的乳腺癌患者在诊断时相对年轻，并且大多数患者不受传统心血管疾病风险因素的影响，使用他汀类药物是否可以改善患者的生存仍不确定。本研究旨在调查他汀类药物在乳腺癌患者的癌症和非癌症相关生存率方面的关联。本队列研究使用台湾的国家医疗保险研究数据库和国家癌症登记处来识别2012年1月至2017年12月间被诊断为乳腺癌的患者。通过倾向得分法，将年龄、癌症分期、抗癌治疗、合并症、社会经济状况和心血管用药进行匹配。统计分析包括Cox比例风险模型，时间从2022年6月到2023年2月，平均（SD）随访时间为4.10（2.96）年。研究比较了在乳腺癌诊断前6个月内接受他汀类药物治疗的患者与未接受他汀类药物治疗的患者之间的差异。结果包括死亡、心力衰竭以及动脉和静脉事件。总共，6753名接受他汀类药物治疗的患者（平均[SD]年龄64.3 [9.4]岁）和6753名未使用他汀类药物的患者（平均[SD]年龄65.8 [10.8]岁）进行了匹配。与非使用者相比，使用所有原因死亡的风险显著降低（调整风险比[HR]，0.83；95％CI，0.77-0.91；P＜.001）。值得注意的是，这种风险降低主要归因于与癌症相关的死亡（调整HR，0.83；95％CI，0.75-0.92；P＜.001）。只有少数患者因心血管原因而死亡，并且两组之间的比率相似。使用时间相关性分析，与非使用者相比，他汀类药物的使用还表现出与癌症相关的死亡风险显着降低（调整HR，0.28；95％CI，0.24-0.32；P＜.001），值得注意的是，高剂量他汀（HDS）使用者与非HDS使用者相比，风险甚至更低（HDS使用者：调整HR，0.84；95％CI，0.73-0.98；P＝.002；非HDS使用者：调整HR，0.79；95％CI，0.68-0.91；P＝.001）。在这项亚洲乳腺癌患者的队列研究中，他汀类药物的使用与乳腺癌相关死亡的风险降低有关，而不是心血管死亡。我们的研究结果为支持在乳腺癌患者中使用他汀类药物提供了证据，不过尚需要进行随机研究。

In addition to protective effects on the cardiovascular system, statins may reduce the risk of breast cancer recurrence owing to potential anti-inflammatory benefits. Given that patients with breast cancer in Asia are relatively younger at diagnosis and most are free from traditional cardiovascular risk factors, it is uncertain whether the use of statins can improve survival.To investigate the association of statin use with cancer- and noncancer-associated survival in patients with breast cancer.This cohort study used the Taiwanese National Health Insurance Research Database and National Cancer Registry to identify patients diagnosed with breast cancer from January 2012 to December 2017. Age, cancer stage, anticancer therapies, comorbidities, socioeconomic status, and cardiovascular drugs were matched by propensity score method. Statistical analyses, including Cox proportional hazards models, were performed from June 2022 to February 2023. The mean (SD) follow-up duration was 4.10 (2.96) years.Patients receiving statins within 6 months before the diagnosis of breast cancer were compared with those not receiving statins.Outcomes included death, heart failure, and arterial and venous events.Overall, 7451 patients (mean [SD] age, 64.3 [9.4] years) treated with statins were matched with 7451 nonusers (mean [SD] age, 65.8 [10.8] years). Compared with nonusers, statin users had a significantly lower risk of all-cause death (adjusted hazard ratio [HR], 0.83; 95% CI, 0.77-0.91; P < .001). Notably, the risk reduction was mainly attributed to cancer-related death (adjusted HR, 0.83; 95% CI, 0.75-0.92; P < .001). Only a small number of patients died of cardiovascular causes, and the ratios were similar between statin users and nonusers. No significant differences were observed in cardiovascular outcomes, including heart failure and arterial and venous events, between statin users and nonusers. Using a time-dependent analysis, statin users also presented a significantly lower risk of cancer-related death (adjusted HR, 0.28; 95% CI, 0.24-0.32; P < .001) than nonusers, and notably, the risk was even lower in high-dose statin (HDS) users compared with non-HDS users (HDS users: adjusted HR, 0.84; 95% CI, 0.73-0.98; P = .002; non-HDS users: adjusted HR, 0.79; 95% CI, 0.68-0.91; P = 001).In this cohort study of Asian patients with breast cancer, statin use was associated with a reduced risk of cancer-associated death rather than cardiovascular death. Our findings provide evidence to support the use of statins in patients with breast cancer; however, randomized studies are necessary.