Cholesterol and Cancer

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I did not know that people with high cholesterol levels have a reduced risk of getting cancer. Did you? All I have ever seen or heard is that cholesterol is bad. But here is an essay by Dr. Malcolm Kendrick with the statement that high cholesterol is associated with low cancer as well as other risks for mortality. This is in his essay about the abuse of science and the corruption of medicine in general and medical journals in particular by pharmaceutical companies with big money.

- Morley


May 24, 2005

STATINS AND CANCER - (NOW IT IS GETTING SILLY)

By Red Flags Columnist, Dr. Malcolm Kendrick

I was not sure whether to even bother responding to the latest news that statins prevent breast cancer. But I think I must, as I believe we are now entering very dangerous ground with statins. We are moving beyond accentuating the positive towards a total distortion of the facts. Over the last year or so, I have seen articles stating that statins prevent Alzheimer’s, prostate cancer, heart failure and now breast cancer. I have seen, and groaned.

"When we looked at statin use prior to breast cancer, what we found was that users of statins were 51 per cent less likely to develop breast cancer as opposed to those who were not using a statin," Dr Khurana said.

How, you may ask, can this be true when the latest TNT study, CARE, J-LIT, ASCOT-LLA and other too numerous to mention seemed to show a significant trend towards increased cancer in those taking statins.

The answer is that these studies are not mutually contradictory – just the way they are interpreted. Dr Khurana’s study was not a placebo controlled clinical trial. He, and his team, merely looked at forty thousand women, and found that those given statins were less likely to have breast cancer.

He decided to interpret this as possible proof that statins protect against cancer. But there are three possible explanations for this finding:

· Chance

· Statins protect against breast cancer

· Women given statins were less likely to get breast cancer in the first place

Explanation one is possible, but uninteresting. Explanation two would contradict many of the statin trails, where rates of cancer were higher in those taking statins. Ergo, it seems unlikely to be correct.

Explanation three, however, fits what is already known about cholesterol levels, statins and cancer risk. Firstly, we know that those given statins will have higher cholesterol levels than those not given statins. Secondly, study after study has shown that people with high cholesterol levels are at a greatly reduced risk of cancer.

You may have seen the study in Geriatrics earlier this year demonstrating that, in the elderly, a low cholesterol level was associated with a doubled risk of death – from all causes - especially cancer. A much, much bigger study was done in Austria, looking at cholesterol levels vs. risk of death. One hundred and fifty thousand people were studied over fifteen years.

‘In men, across the entire age range, although of borderline significance under the age of 50, and in women from the age of 50 onward only, low cholesterol was significantly associated with all-cause mortality, showing significant associations with death through cancer, liver diseases, and mental diseases.’

So, we give statins to a group of women who – because they have high cholesterol levels – are at a significantly reduced risk of cancer. When they are found to have a lower risk of cancer on statins, we claim that statins reduce the risk of cancer.

We then receive large sums of money from statin manufacturing company X. We then become a respected international opinion leader. We are then asked to sit on committees making up guidelines on the prevention of heart disease. We then act as peer-reviewers for journals so that when someone writes a letter such as the one below, written to the NEJM – we can reject it.

TO THE EDITOR: La Rosa et al.(1) claim to have shown significant clinical benefit from 80mg of atorvastatin per day compared with 10mg per day. The clinical benefits claimed were solely in selected cardiovascular end points. There was no increase in overall survival since there were more deaths from malignancies and other fatal conditions. For every malignancy that was fatal, or other condition that proved fatal, many more malignancies or other potentially fatal conditions must have been diagnosed. The morbidity from serious non-cardiac conditions is never considered in studies of statins where there is no increase in survival with treatment.

Exchanging a cardiac death for the prolonged misery of death from a malignancy or from another fatal condition can hardly be claimed to be a clinical benefit. The purveyors of the statins need to look with more objectivity at the overall effects of those agents. Even when there is an apparently impressive increase in overall survival, the real gains are negligible (2).
Louis H. Krut, MB.ChB., M.D.

1. La Rosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;323:1425-35.
2. Krut LH. On the statins, correcting plasma lipid levels, and preventing the clinical sequelae of atherosclerotic coronary heart disease. Amer J Cardiol 1998;81:1045-6.

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