Statins

This page is being created at the request of members of the Barrett's Esophagus Awareness Facebook group.

It will look at the current research into supplementing PPI drugs with other known drugs that may increase the chemo-protective effect.

N.B. Much of this is on-going and those with Barrett's are advised not to experiment themselves but discuss with a doctor if they wish.

Below are the links, in chronological order, of links to relevant research papers harvested from the Research Archive which ran from 2012 to 2022 and fuelled much of the content of this encyclopaedia.

Extra links to relevant research may be added later.

N.B. This list is in a raw state and will be tidied into a suitable page format at a later date.

Dark blue highlights positive findings; Dark red negative.

23 Oct 2012 Statins May Reduce Risk Of Esophageal Cancer. "A new US review of published evidence from studies looking at the cancer prevention effects of statins, finds taking the cholesterol-bustings drugs may cut people’s risk of developing esophageal cancer (cancer of the gullet)". (Medical news Today)

6 August 2013 Reduced esophageal cancer incidence in statin users, particularly with cyclo-oxygenase inhibition. "Statin use in patients with Barrett's oesophagus is associated with a significantly lower incidence of adenocarcinoma." (World Journal of Gastroenterology)

5 December 2013 Statin Use is Associated With Reduced Risk of Histologic Subtypes of Esophageal Cancer: a Nested Case-Control Analysis. "satin use was inversely associated with histologic subtypes of esophageal cancer" (Gastroenterology)

31 December 2013 Statins and Aspirin for Chemoprevention in Barrett's Esophagus: Results of a Cost-Effectiveness Analysis. "Combination therapy using both aspirin and statin is expensive but could be cost-effective in patients at higher risk of progression to EAC." (Cancer Prevention Research)

6 February 2014 Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett's esophagus. "non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents ... meanwhile, their use is justified only in patients with cardiovascular disease." (World Journal Gastrointestinal Pharmacology)

2 May 2014 Statin Use is Associated with a Decreased Risk of Barrett's Esophagus. "statin use was associated with a reduced risk of Barrett's esophagus" (Gastroenterology)

August 2014 Barrett's oesophagus: Evidence from the current meta-analyses. "These results demonstrate that guidance regarding surveillance based on the presence of intestinal metaplasia, segment length and the presence of low-grade dysplasia has a weak basis, and further consideration should be given to gender and helicobacter status, ablation of the metaplastic segment as well as the chemoprotective role of aspirin and statins. (World Journal of Gastrointestinal Pathophysiology)

December 2014 Metformin use and the risk of esophageal cancer in barrett esophagus. "The three independent variables that predicted progression of Barrett esophagus to esophageal adenocarcinoma in our study were older age, smoking, and diabetes mellitus. Statin use showed protective effect against development of esophageal adenocarcinoma. Metformin use did not demonstrate any statistically significant protective effect." (Southern Medical Journal)

29 January 2015 NSAIDs, statins, low-dose aspirin and PPIs, and the risk of oesophageal adenocarcinoma among patients withBarrett's oesophagus: a population-based case-control study. "PPIs, low-dose aspirin or statins did not reduce the risk of HGD and OAC among patients with BO." (BMJ open)

14 February 2015 Medical Prevention of Barrett's Esophagus: Effects of Statins, Aspirin, Non-aspirin NSAIDs, Calcium, and Multivitamins. "GERD patients with BE are less likely to use multivitamins and statins, as well as less likely to be of Hispanic ethnicity." (Digestive Diseases &Sciences)

February 2015 Barrett's oesophagus: Frequency and prediction of dysplasia and cancer. "Factors that may protect against the development of adenocarcinoma include a diet rich in fruits and vegetables, and the use of proton pump inhibitors, aspirin/NSAIDs and statins" (Best Practice & Research: Clinical Gastroenterology)

21 July 2015 Statin Use Reduces Risk of Esophageal Adenocarcinoma in US Veterans With Barrett's Esophagus: a Nested Case-Control Study "statin use among those with BE appeared to decrease the risk of EAC. This protective effect was strongest against advanced-stage EAC, and increased with statin dose" (Gastroenterology)

19 September 2015 Reduced Risk of Barrett's Esophagus in Statin Users: Case-Control Study and Meta-Analysis. "Regular statin use was associated with a significantly lower incidence of Barrett's esophagus compared to the combined control groups. ... The inverse association between statin or statin plus aspirin use and risk of Barrett's was significantly greater with longer duration of use." (Digestive Diseases and Sciences)

6 January 2016 Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett's esophagus cohort. "In this large population-based cohort of BE subjects, increasing age, male gender, and being overweight predicted progression to EC whereas PPI and statin use were protective against EC development" (Gastrointestinal endoscopy)

6 May 2016 Barrett’s esophagus in 2016: From pathophysiology to treatment "The area of BE therapeutic management is rapidly evolving. Unequivocal data on the use of drugs such as PPIs, aspirin or statins in the chemoprevention of BE are lacking. At the moment, there is no doubt regarding the use of PPIs for symptom control[58,59]. Endoscopic eradication therapies have been shown to be effective in patients with BE/EAC, and new therapies have appeared. BE containing HGD and/or early-stage EAC can be treated endoscopically instead of with surgical esophagectomy." (World Journal Gastrointestinal Pharmacology and Therapeutics)

13 September 2016 Opportunities for preventing esophageal adenocarcinoma. "Preventive effects were found based on medium level observational evidence following treatment of gastroesophageal reflux disease (both using medication and surgery) and tobacco smoking cessation, which should be clinically recommended among exposed patients. Non-steroidal anti-inflammatory drugs appears to prevent esophageal adenocarcinoma, and the limited existing data also indicates a protective effect of medication with statins or hormone replacement therapy in women, but current evidence is insufficient to guide clinical decision-making regarding these drugs. The evidence is presently insufficient to assess the potentially preventive role of weight loss." (Cancer Prevention Research – Philadelphia)

18 October 2016 The Role of Chemoprevention in Barrett's Esohagus "Since the vast majority of patients with BE have associated GERD symptoms, PPIs should be given to control GERD and doses should be adjusted to achieve adequate control of GERD-related symptoms. Presently, NSAIDs, aspirin, statins, and bile acid sequestrants should not be prescribed routinely to patients with BE." (Gastroenterology & Endoscopy News)

10 July 2017 Systematic Review and Meta-analysis: Use of Statins Is Associated with a Reduced Incidence of Oesophageal Adenocarcinoma. "Statin use is associated with a significantly lower incidence of oesophageal adenocarcinoma. This is seen in both Barrett's cohorts and general populations." (Journal of Gastrointestinal Cancer)

8 September 2017 Additional Benefits of Routine Drugs on Gastrointestinal Cancer: Statins, Metformin, and Proton Pump Inhibitors. "Recent observational studies have demonstrated that PPIs effectively reduce the progression of nondysplastic Barrett's esophagus into esophageal adenocarcinoma in a dose-dependent manner. However, the association between chronic PPI use and CRC or gastric cancer risk is still controversial." (Digestive Diseases)

28 October 2017 Do Statins Increase the Risk of Esophageal Conditions? Findings from Four Propensity Score-Matched Analyses. "statin users were more likely to be diagnosed with esophagitis .. and gastroesophageal reflux disease/dyspepsia .. compared with non-users. ... In sensitivity analyses, which excluded patients with obesity, statin use was not associated with an increased odds ratio of gastroesophageal reflux disease/dyspepsia." (Clinical Drug Investigation)

15 June 2018 Natural History of Barrett's Esophagus. (full text) "The incidence of high-grade dysplasia and cancer in BE depends on segment length, gender, and age. The latter two likely indicate the duration of the presence of BE in an individual patient. Other factors that influence the incidence of dysplasia and cancer are smoking behavior and use of certain medications such as PPIs, statins, and NSAIDs. Surveillance of BE and treatment of dysplasia can impact the incidence of and mortality due to esophageal adenocarcinoma. This is of major benefit to a subgroup of BE patients." (Digestive Diseases & Sciences)

29 June 2018 Acid suppression medications reduce risk of oesophageal adenocarcinoma in Barrett's oesophagus: a nested case-control study in US male veterans. (full text) "In summary, we found PPI use to be associated with 41% lower risk, and H2RA use with 30% lower risk of Barrett's oesophagus progression to OAC after adjusting for multiple confounders including statin, aspirin, and NSAID use.)" (Alimentary Pharmacology & Therapeutics)

3 February 2019 Impact of Chronic Statins Use on the Development of Esophagitis in Patients with Gastroesophageal Reflux Disease. (full text) "Using chronic statins was protective to the development of esophagitis among GERD patients. Our findings of potential clinical application mandate further randomized controlled trials to better assess the impact of statins on esophagitis." (Canadian Journal of Gastroenterology & Hepatology)

27 May 2019 Clinical characteristics may distinguish patients with esophageal adenocarcinoma arising from long- versus short-segment Barrett's esophagus "Patients who developed EAC on a background of LSBE were more likely to have a hiatus hernia compared to patients with SSBE EAC, who were more likely to have higher smoking pack-years and higher rates of statin use." (Digestive & Liver Disease)

May 2019 Barrett oesophagus "Developments in endoscopic therapy have resulted in a major shift in the treatment of patients with BE who have dysplasia or early EAC, from surgical resection to endoscopic resection and ablation. In addition to symptom control by optimization of lifestyle and pharmacological therapy with proton pump inhibitors, chemopreventive strategies based on NSAIDs and statins are currently being investigated for BE management." (Nature Reviews)

July 2019 Management of Barrett Esophagus Following Radiofrequency Ablation "Additional studies are needed to determine the length of time patients should ultimately remain in surveillance programs. Uncertainty exists regarding the appropriate application of chemopreventive measures (including proton pump inhibitors, aspirin, and statins) and novel imaging and sampling modalities (such as optical coherence tomography and wide-area transepithelial sampling) to reduce the risk of recurrent disease and sampling error, respectively." (Gastroenterology & Hepatology)

August 2019 Screening and Prevention of Barrett's Esophagus "In order to prevent the development of BO or its neoplastic progression, there are modifiable risk factors like obesity or smoking that can be influenced. In addition, several drugs like proton pump inhibitors, aspirin, nonsteroidal anti-inflammatory drugs and statins have shown promising effects in mostly observational studies." (Viceral Medicine)

11 October 2019 Statins and gastroesophageal reflux disease: A meta-analysis "The current meta-analysis found that the risk of GERD was numerically lower among statin users although the pooled result did not reach statistical significance. Therefore, more studies are still needed to further clarify this potential benefit of statins." (Journal of Postgraduate Medicine)

4 August 2020 Chemoprevention of esophageal adenocarcinoma (full text) "Aspirin and other non-steroidal anti-inflammatory drugs have moderate quality observational and randomized-trial evidence for preventing progression of BE to EAC, but their risks for harm have precluded their routine clinical use. Other therapies (statins, metformin, female sex hormones) generally do not have strong evidence to support their use in EAC chemoprevention." (Gastroenterology Report)

30 September 2020 Association of common use pharmaceuticals in reducing risk of esophageal adenocarcinoma: A SEER-Medicare analysis "Dual use of PPIs with NSAIDs, or statins, and NSAID, statin, or metformin use alone also showed significant EAC risk reduction among all participants and those without BE. Use of PPIs alone, and with NSAIDs, statins, or metformin was associated with reduced risk of EAC, however history of BE may diminish drug efficacy." (Cancer Prevention Research)

26 October 2020 Current Status of Chemoprevention in Barrett's Esophagus "Candidates for chemoprevention in Barrett's esophagus have long been suggested and there has been observational data to support many drugs, including statins, hormone replacement therapy, metformin, proton pump inhibitor therapy, and aspirin. Proton pump inhibitor therapy and aspirin are the most promising agents. Data suggest that aspirin and proton pump inhibitor therapy can decrease the risk of neoplastic progression in Barrett's esophagus. Further, the combination of aspirin and proton pump inhibitor therapy decrease all-cause mortality by approximately 33%." (Gastrointestinal Endoscopy Clinics of North America)

4 June 20022 Statins and the risk of gastric, colorectal, and esophageal cancer incidence and mortality: a cohort study based on data from the Korean national health insurance claims database “Statin use for at least 6 months was significantly associated with a lower risk of stomach, colorectal, and esophageal cancer incidence as well as cancer mortality after a diagnosis.” (Journal of Cancer Research & Clinical Oncology)

Possible adverse effects?

February 2018 Do Statins Increase the Risk of Esophageal Conditions? Findings from Four Propensity Score-Matched Analyses

"Statin therapy was associated with higher odds of being diagnosed with esophagitis and gastroesophageal reflux disease/dyspepsia. Further study is warranted to elucidate the potential role of statins in these commonly diagnosed esophageal conditions. " (Clinical drug Investigation)

From Drugs.com: Drug Interactions between atorvastatin and omeprazole

“Combining these medications may increase the blood levels and effects of atorvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue.”

"A case report suggests that coadministration with esomeprazole may increase the plasma concentrations of atorvastatin and the associated risk of myopathy. "

"Because of the increased risk of musculoskeletal toxicity associated with high levels of HMG-CoA reductase inhibitory activity in plasma, patients treated with atorvastatin, lovastatin, simvastatin, and red yeast rice (which contains lovastatin) should be monitored more closely during concomitant use of proton pump inhibitors."

Page updated 14 February 2023