Longer-term lipid-lowering drug use and risk of incident and fatal prostate cancer in black and white men in the ARIC Study.

Lipid-lowering medications, particularly statins, may protect against aggressive prostate cancer. Fatal prostate cancer, the most clinically relevant outcome, remains understudied for this association. We prospectively studied lipid-lowering medication use and both incident and fatal prostate cancer in black and white men in the Atherosclerosis Risk in Communities (ARIC) Study. 6,518 men without cancer at visit 2 (1990-1992), the start of the statin era, were followed for prostate cancer incidence and death through 2012. Medication use was collected during study visits and telephone calls at up to 9 time points during follow-up. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of total (white N=541, black N=259) and fatal (white N=56, black N=34) prostate cancer overall and by race. Lipid-lowering medication use was modeled as time-dependent current use or duration (never, <10, ≥10 years). By visit 4 (1996-1998), 21% of white and 11% of black men had used a lipid-lowering medication, mostly statins. There was a suggestion that current users were less likely to die from prostate cancer than non-users (HR=0.67, 95% CI=0.42-1.07) after multivariable adjustment. We observed no statistically significant differences between black and white men. Current use was not associated with incident prostate cancer, although long-term use was statistically significantly inversely associated with incidence (HR=0.68, 95% CI=0.50-0.92). Long-term lipid-lowering medication use was associated with lower risk of prostate cancer. Current use was possibly associated with fatal prostate cancer.