Statin use reduces radiation-induced stroke risk in advanced nasopharyngeal carcinoma patients

•Different statin classes showed protective effects: hydrophilic statins (aHR: 0.37, 95% CI: 0.17–0.85), lipophilic statins (aHR: 0.32, 95% CI: 0.21–0.50).•Cumulative defined daily doses (cDDD) showed dose–response relationship for stroke risk reduction.•Pravastatin and atorvastatin demonstrated significant reductions in stroke occurrence.•Statin use during CCRT period associated with lower risk of radiation-induced stroke in NPC patients.•Implications for stroke risk reduction warrant further investigation in clinical trials. This cohort study aimed to evaluate the impact of statin use on ischemic stroke risk in patients with advanced nasopharyngeal carcinoma (NPC) undergoing standard concurrent chemoradiotherapy (CCRT). Using data from the Taiwan Cancer Registry Database, we conducted an inverse probability of treatment-weighted Cox regression analysis to examine the association between statin use during CCRT and ischemic stroke risk. The adjusted hazard ratio (aHR) for ischemic stroke in the statin group compared to the non-statin group was 0.70 (95 % CI: 0.54–0.92; P 1 had a reduced risk of stroke with an aHR of 0.49 (95 % CI: 0.31–0.63), while those with DDD ≤ 1 showed an aHR of 0.59 (95 % CI: 0.40–0.84). Our study provides evidence supporting the beneficial effects of statin use during the CCRT period in reducing radiation-induced stroke risk among patients with advanced NPC undergoing definitive CCRT. Notably, pravastatin and atorvastatin demonstrated significant reductions in stroke occurrence. Furthermore, the findings suggest a dose–response relationship, where higher cumulative doses and greater daily dose intensity of statin use were associated with a lower risk of stroke.