Statin use not linked to cancer

NEW YORK (Reuters Health) - Although lower levels of LDL-cholesterol seem to correlate with higher rates of cancer, treatment with statin agents does not increase the risk of malignant neoplasia, according to a report in the August 20th online issue of the Journal of the American College of Cardiology.

Statin use not linked to cancer

Last Updated: 2008-08-20 17:29:56 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Although lower levels of LDL-cholesterol seem to correlate with higher rates of cancer, treatment with statin agents does not increase the risk of malignant neoplasia, according to a report in the August 20th online issue of the Journal of the American College of Cardiology.

"Only one previous study has examined whether there is a relationship between LDL levels and cancer, and that was our paper published last summer that showed that lower LDL levels are associated with higher rates of cancer in a large population of statin-treated patients," senior author Dr. Richard H. Karas told Reuters Health.

"In the current study," Dr. Karas, a researcher with Tufts Medical Center in Boston, added, "we now show that the relationship between lower levels of LDL cholesterol and a higher risk of cancer is present in both statin-treated and similar non-statin treated controls. These novel findings suggest that the relationship is not driven by statins."

The current findings are based on an analysis of data from 15 randomized controlled trials of statin therapy, which provided on-treatment levels of LDL-cholesterol and incident cancer rates. Together, the studies included 19 statin and 14 control arms, over 400,000 person-years of cumulative follow-up, and nearly 6000 incident cancers.

Meta-regression analysis in the statin arms showed an inverse link between on-treatment LDL-cholesterol levels and incident cancer. For every 10 mg/dL drop in LDL-cholesterol, an excess of 2.2 cancer per 1000 person-years was seen (p = 0.006). The corresponding difference in the control arms was not statistically significant.

Nonetheless, the researchers found no evidence of a cancer-promoting effect for statins across all levels of on-treatment LDL-cholesterol.

While calling the findings reassuring, editorialists Dr. Ori Ben-Yehuda and Dr. Anthony N. DeMaria, from the University of California, San Diego, believe that further studies are needed to fully verify the safety of statin therapy.

Supporting this belief, they note, are the preliminary results of the SEAS study, which showed a significantly increased rate of cancer in patients treated with simvastatin/ezetimibe compared with those given placebo.

Although emphasizing that the cumulative evidence to date does not support a pro-cancer effect for statins, Dr. Karas notes that there are two key questions that need to be addressed in future studies: "Is the association between lower levels of LDL and higher rates of cancer a 'cause and effect' relationship?" and "What is the underlying biology that might cause an association between lower levels of LDL and higher risks of cancer?"

J Am Coll Cardiol 2008;52.