ORIGINAL RESEARCH
Xiaohan Qiu, MD; Qinxiao Li, MD; Xinyu Xu, MD; Longyu Wang, MD; Jiahan Ke, MD; Min Wang, MD; Huasu Zeng, MD; Yong Tang, MD; Jun Gu, MD
Corresponding Author: Jun Gu, MD; Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine.
Email: gjforsub@163.com
DOI: 10.3122/jabfm.2025.250407R2
Keywords: Cancer Survivors, Cardiology, Cardio-Oncology, Cardiovascular Diseases, Cohort Studies, Logistic Regression, Mortality, Nutrition Surveys, Oxidative Stress, Primary Health Care, Proportional Hazards Models, Statins
Dates: Submitted: 10-23-2025; Revised: 12-13-2025; 12-23-2025; Accepted: 01-06-2026
Status: In Press.
BACKGROUND: Cancer survivors face elevated cardiometabolic risks despite improved treatments. While statins demonstrate pleiotropic effects beyond lipid-lowering, their protective effects against cardiometabolic diseases in cancer survivors remain unclear.
METHODS: This cohort study analyzed NHANES data including 4,208 cancer survivors. Statin use was assessed through medication interviews. Primary outcomes included all-cause mortality, cardiometabolic mortality, and cardiometabolic diseases from mortality archives through December 2019 and self-reported histories. The Oxidative Balance Score (OBS), comprising 16 dietary nutrients and 4 lifestyle components, evaluated oxidative stress levels. Cox proportional hazards models and logistic regression analyses were performed with comprehensive adjustments, including baseline cardiovascular comorbidities.
RESULTS: Among 4,208 cancer survivors (361 statin users, 3,847 nonusers), 1,774 deaths occurred during follow-up, including 673 cardiometabolic deaths. After full adjustment, statin use was associated with reduced all-cause mortality (HR, 0.83; 95% CI, 0.69-0.97; P=0.025) and cardiometabolic mortality (HR, 0.75; 95% CI, 0.59-0.98; P=0.041). Statin users also showed lower risks of cardiovascular disease and stroke. Protective associations were consistent across subgroups and cancer types. Significant additive interactions between statin use and oxidative stress were observed (RERI for all-cause mortality: 0.28; 95% CI, 0.05-0.51), suggesting oxidative stress mitigation as a potential mechanism.
CONCLUSIONS: In this nationally representative cohort, statin use among cancer survivors was associated with significantly reduced cardiometabolic disease risks, all-cause mortality, and cardiometabolic mortality, potentially through oxidative stress mitigation. Statins represent a promising therapeutic strategy for improving cardiovascular outcomes in cancer survivors.