Very Low LDL May Mean More Cancer Risk

saluki

Talk about Crazy Meds---Damned if you do Damned if you Don't.
Who knows what is right anymore.

July 24, 2007

Very Low LDL May Mean More Cancer Risk
Risk Found in People Taking Statin Drugs; More Study Needed, Researchers Say

By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD

July 23, 2007 -- New research suggests a link between very low cholesterol levels and an increased risk of cancer, but the findings are far from conclusive, researchers say.

The analysis of studies examining outcomes in patients taking cholesterol-lowering drugs called statins to lower their low density lipoprotein (LDL) "bad" cholesterol found an elevated risk of cancer among those who achieved the very lowest LDL cholesterol levels while taking the drugs.

The findings do not directly implicate statins in increasing cancer risk, but they do raise important questions, which need to be answered in future clinical trials, researcher Richard H. Karas, MD, of Boston’s Tufts-New England Medical Center, tells WebMD.

Statins like Lipitor, Pravachol, Crestor, and Zocor lower LDL levels by blocking a key enzyme in the liver responsible for making cholesterol.

“Our findings should not be seen as a reason to change clinical practice,” Karas says. “No one who needs these drugs should stop taking them based on these findings.”
Is Lower Always Better?

Millions of American take statins to lower their risk of heart attack and stroke, and in recent years an increasing number have been placed on high doses of the drugs to achieve lower LDL levels.

The “lower is better” strategy for controlling LDL has been shown to reduce cardiovascular risk, especially in very high-risk heart patients. But questions remain about the long-term safety of high-dose statin use.

Karas and colleagues did not have cancer in mind when they set out to examine the safety of the strategy. They were more focused on two more widely suspected side effects of statins -- muscle damage and elevated liver enzymes.

They found no link between very low LDL levels and either of these side effects, but a clear association was seen between statin use in high doses and liver abnormalities.

“There was an important and significant relationship between the dose of statins given and the risk of liver toxicity,” Karas says. “I think this paper establishes that point quite strongly.”

The analysis failed to show a similar link between statin dosage and muscle damage. It has long been suggested that in high doses statins raise the risk of a rare but potentially life-threatening muscle disorder known as rhabdomyolysis.

No evidence of a link was found by Karas and colleagues, but the researcher says there were too few cases of the disorder to prove or disprove the association.

Karas favors using moderate doses of statins in combination with other cholesterol-lowering drugs instead of high doses of statins to lower the risk to the liver.

"To be clear, the benefits of statins far outweigh the risks,” he says.
Statins, Cancer, and Controversy

It is not clear from the analysis if the increased cancer risk seen in patients with very low LDL had anything to do with statin use.

The study is published in the July 31 issue of the Journal of the American College of Cardiology (ACC).

In an interview with WebMD, ACC President James Dove, MD, FACC, expressed concern that it would be misinterpreted by the press and public.

“It would be wrong to conclude that the drugs are too risky because of this unproven cancer risk,” he says. “These results raise important questions, but they do not demonstrate a causal relationship between statins and cancer.”

Editors of the ACC journal expressed a similar apprehension in an editorial accompanying the research analysis.

“Given the growing public angst regarding the safety of prescription medications, all were concerned that the paper contained great potential both for harm and good,” editors Anthony DeMaria, MD, and Ori Ben-Yehuda, MD, write.

The study prompted “spirited discussions” among editorial board members, with some arguing that the paper should not be published, the editors write.

“In the final analysis, the consensus was that these findings could not be ignored, that they did indeed warrant further investigation, and that they should be aired in public,” they conclude.

Lipitor manufacturer Pfizer issued a statement late Monday in response to the study, noting that “the existing pre-clinical and clinical evidence does not support a causal association between the use of statins and the development of cancer.”

A Pfizer spokeswoman pointed to a large analysis of 26 studies including nearly 90,000 patients published last year, which showed no evidence of an increased risk of cancer with statin use.

“A limitation of the current analysis is that researchers took data from clinical trials available before November of 2005,” the statement reads. “We agree with the authors that further analysis in this area is appropriate, but should include all currently available trials.”



* Learning about cholesterol and how it affects your daily health needs? Ask or expert Michael Richman, MD, FACS, a question here on the Cholesterol Management message board.

SOURCES: Alsheikh-Ali, A. Journal of the American College of Cardiology, July 31, 2007; vol 50: 409-418. Richard H. Karas, MD, PhD, director of preventive cardiology, Tufts-New England Medical Center, Boston. James Dove, MD, FACC, president, American College of Cardiology. Anthony DeMaria, MD, MACC, editor-in-chief, Journal of the American College of Cardiology, San Diego. Rebecca Hamm, spokeswoman, Pfizer Pharmaceuticals.
© 2007 WebMD, Inc. All rights reserved.
©2005-2007 WebMD, Inc. All rights reserved.

roseg

At one time wasn't there some thought that statins might help reduce colon cancer? Maybe that's the study they mention.

ginger2345

I wouldn't stop taking my statin based on this research--the title even says "more study needed."

Statins have proven effective in lowering heart disease risk and this risk is more real for most Americans as we continue to bulge at the waistline.

A few years ago there was "thought" and "talk" that statins protected against colon cancer--but nothing that could be put on the label. I'm not sure where that stands as I've not heard talk of it lately.

rubytuesday

Thanks Saluki for the info....reason number 9999 not to take a statin...................

Anonymous

Well, I just love this stuff.

When I was doing chemo and had my cholesterol taken from my pcp my LDL was only 48! Lowest in the practise. My onc said they don't pay attention to cholesterol during chemo.

I take 10 mg of Lipitor and have for years. At this point I won't stop. I also take fish oil in hopes that will help also. My LDL is 86 right now. I don't think that's too low.
Shirley

Anonymous

My LDL is 81 and the first doctor who ran it said that it, along with my other numbers (HDL=98/triglicerides=50/total cholesterol=188), was GREAT! But my PCP said that she'd like to see it even lower and told me to halve my fish oil supplement intake.

Sometimes I get sick of too much information/advice/opinion even though some things are essential to know about....sigh.

Marin

Rosemary44

They're going a little bit overboard on LDL being so low. I swear it's to get us all on statins. I wonder where this got it start? For years it was ok to have an LDL just under <100. They come up with new drugs geared to lower LDL, and bingo, we now have new research saying we all need to be way under 100? R-I-G-H-T.

Anonymous

Marin, with your HDL being so high your ratio must be fantastic! Your triglycerides were great also. Here's my opinion, FORGET WHAT YOUR PCP said. LOL
Shirley

Jorf

Rosemary, I think it was that they just wanted to sell more. The drugs had been on the market for a long time before they started doing these studies. The first I heard of the decrease in the LDL for high risk was about 5 years ago at a lipitor drug dinner.... There were a series of tests showing no lower limit for the decrease in LDL decreasing major cardiovascular events. Who knows what's next....

Rosemary44

Jorf,

When zetia came out, and I don't know exactly when, that's when I first heard that I now have to be under 70. Lipitor probably could have done it, but I refused to go on a higher dose of it. I began to see zetia ads on TV and then at my Dr.s office, and then the prescription was in my purse. It was so amazing.

ravdeb

My family doctor told me it should be hovering around 100. My daughter who is only 23 has high cholecsterol that can be managed by diet. She got her LDL to 100 and he said that was fine. Mine is 72 with 20 mg of statins and I think that is too low.