Pharmacologic Potential of Statins in Cancer Prevention: Colo-Rectal Cancer Risk in Dyslipidemic Patients from a Korean Nationwide Cohort

Background/Objectives: Colorectal cancer (CRC) is a growing public health concern in South Korea, with incidence rising alongside dyslipidemia. Statins, widely prescribed for lipid control, have been proposed to reduce CRC risk, but evidence remains inconsistent, particularly in Asian populations. Methods: Using Korean National Health Insurance Service data (2002–2019), we conducted a nested case–control study of 9920 CRC patients and 39,680 matched controls. To reduce confounding, we applied a matching process with a propensity score and overlap weighting based on demographic and clinical variables. Statin use within two years before CRC diagnosis was categorized by type (lipophilic vs. hydrophilic) and duration. Lifestyle data such as smoking and diet were not available. Results: Short-term statin use was associated with a 17% reduced CRC risk, particularly in younger, metabolically healthier Korean males. Lipophilic statins were consistently associated with lower CRC risk and mortality. However, hydrophilic statins showed mixed results: while short-term use lowered CRC risk, long-term use was linked to increased all-cause mortality. These associations varied by patient subgroup. Conclusion: Among Korean adults, short-term statin use—especially lipophilic agents—was associated with favorable CRC outcomes. However, the observational design, the absence of lifestyle data, and increased mortality linked to long-term hydrophilic statin use limit causal interpretation. Further research using clinically enriched or prospective datasets is warranted to validate these findings and guide personalized preventive strategies.