Combined use of aspirin, metformin, and statins may be associated with decreased lung cancer incidence and mortality, according to a study published by Kang et al in the Journal of Thoracic Oncology.

Study Methods

The aim of this study was to investigate the associations of the three agents with lung cancer risk and mortality using population-based nationwide cohort data from the Korean National Health Insurance Services (KNHIS) database. The KNHIS is a health-care system that covers the entire Korean population of 50 million.

“To our knowledge, no study has evaluated aspirin, statins, and metformin use and their combined impact on lung cancer incidence and mortality,” said lead study author Dong Wook Shin, MD, DrPH, MBA, of the Sungkyunkwan University School of Medicine in Seoul, Korea.

Researchers examined information from 732,199 people in the KNHIS database. The patients were followed between January 2004 and December 2013. Lung cancer incidence and mortality were identified using a registered lung cancer diagnosis code (ICD-10 code C34) and the Korean National Death Registry.

To address the combined associations of these cardiovascular drugs with lung cancer risk and mortality, the researchers categorized the cohort into eight groups, based on exposure to aspirin, statins, and metformin.

Key Findings

Combined use of aspirin, statins, and metformin was associated with decreased lung cancer incidence (adjusted hazard ratio [aHR] = 0.83, 95% confidence interval [CI] = 0.69–0.99) and mortality (aHR = 0.83, 95% CI = 0.70–0.99) compared with not using the agents.

“When these cardiovascular drugs were used in combination, their protective associations with lung cancer risk and related mortality were augmented and the magnitude of effect increased with increasing duration of medication use,” said Dr. Shin.

Metformin use had a protective association with lung cancer incidence and mortality in a dose-response fashion. Lung cancer mortality was dose-dependently reduced with the use of aspirin and statins.

From 2012 to 2013 period (the most recent period in the study), 3.4% of study participants were taking all three medications (23,163 patients of 676,520). 

“Interestingly, the inverse association of combined use of aspirin, statins, and metformin was prominent, and the longer the duration of combined use, the more protective the association. This finding is in line with a study demonstrating that aspirin and metformin synergistically inhibit lung cancer cell proliferation by activating AMP-activated protein kinase, which plays a critical role in regulation of lipogenesis in cancer cells,” said Dr. Shin.

The study authors concluded: “Use of aspirin, metformin, and statins had independent protective associations with lung cancer mortality, and metformin had inverse association with lung cancer risk. Further studies are necessary to develop clinically applicable anticancer strategies of these drugs for the reduction of lung cancer and related mortality.”

Disclosure: For full disclosures of the study authors, visit jto.org.