Statin initiation among cancer survivors with asymptomatic coronary atherosclerosis

Cancer survivors are at higher risk of developing heart disease, but it is unclear whether they receive adequate preventive care. This study aimed to compare the statin initiation rates between cancer survivors and non-cancer controls. Cancer survivors and similar statin-naïve controls were recruited from the community. Intermediate risk participants, based on their conventional cardiovascular risk factors, were referred for coronary artery calcium score (CACS). This result was relayed to participants’ primary care provider (PCP), who determined therapy. Multivariable logistic regression models were constructed to identify the associations between cancer history and statin initiation by PCP. This study compared management of 97 cancer survivors (median age 67 [64–70] years, 84.5% female) and 109 non-cancer controls (median age 64 [60–67] years, 36.7% female). The median CACS for survivors and controls were 62 [16–124] and 144 [28–554] followed by the overall statin prescription rates of 54% and 69%, respectively. Multivariable logistic regression showed that cancer history was not associated with statin initiation by PCP after adjustment for CACS, age, sex and other cardiovascular risk factors. Statin prescribing by primary care providers was generally aligned with guideline recommendations and did not differ substantially by cancer history. However, many individuals with any detectable coronary calcium (CACS > 0) remained untreated, despite this being a clear marker of elevated risk of atherosclerotic cardiovascular disease. These findings suggest that undertreatment may not be driven by clinical inertia alone, underscoring the need to explore alternative barriers to preventive care in this vulnerable population.