COMMENTARY

Statins and Cancer Mortality: Some Comfort

Henry R. Black, MD

Disclosures

February 25, 2013

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Hi. I am Dr. Henry Black, Clinical Professor of Internal Medicine at the New York University Langone School of Medicine and a former president of the American Society of Hypertension. I am a member of the Center for the Prevention of Cardiovascular Disease at New York University.

The treatment of high cholesterol has been revolutionized by the appearance of HMG-CoA reductase inhibitors, also known as statins. These drugs were introduced in the late 1980s and 1990s. Prior to that, we had resins or surgery, and we weren't getting very far. Statins are now widely used throughout the world and have significantly reduced the incidence of cardiovascular disease, particularly coronary disease, although it is not clear whether statins have reduced the incidence of stroke.

Drugs that are used this widely tend to get blamed for things. Sometimes these drugs appear disappointing because people expect them to do more than they were designed to do. One of the things that has been disappointing in the statin studies is that they don't seem to reduce cancer incidence or cancer mortality, even though lowering serum cholesterol might reduce the availability of some of the products to make cell membranes required by malignant cells.

A group of investigators in Denmark have looked at their entire population, including those who had cancer diagnoses and those who did not, to see whether people had taken statins before their diagnosis of cancer.[1] They had more than 18,000 cases of cancer in people who had taken statins and about 277,000 cases of cancer in people who had not taken statins. The study encompassed patients from 1995 to 2007, and the investigators waited 2 more years to see whether any effects would appear later on.

They found that, overall, no matter what dose of statin patients were taking, statins reduced cancer mortality by about 15%. They didn't examine cause-specific mortality; this finding was across-the-board. Yet, this wasn’t found in previous individual clinical trials. We now have the use of a database with very careful measurements vs the clinical trials in which no effect on mortality was seen.

These findings suggest that the use of statins primarily for cardiovascular disease might also reduce cancer mortality. By 5 years, all-cause mortality wasn't lower in patients taking statins because many were dying of cardiovascular disease.

We can take some comfort that the widespread use of statins is not a prophylactic against cancer, but when statins are given for specific indications, they are not likely to increase cancer mortality -- and might actually reduce it.

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