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If Low LDL Could Lead to Cancer, Then Are Statins Responsible?

Answered on September 12, 2014
Created March 26, 2012 at 5:50 AM

Some people used to argue that if LDL falls too low, you're susceptible to cancer. It was never very clear to me that this was entirely true. First, how low must your LDL be to be cancer-susceptible? Under 100? Under 50? Second, wouldn't your LDL fall as a result of cancer. That is, isn't low LDL an ex post phenomenon, as cancer diagnoses tend to be made when your body's feeling the effects of, if not being ravaged by, cancer?

Well, it seems that's not true after all. In fact, the new finding supports the Paleo position that the low LDL may signal and anticipate cancer diagnosis down the road.

Researchers who presented at the American College of Cardiology???s (ACC) Expo confirmed that low LDL levels existed for 18.7 years prior to cancer diagnosis. Wow, 18.7 years, that's a long time. It's hard to argue against that kind of data. Imagine, someone who ended up being dx'ed with cancer later already had a low LDL compared to someone who was never cancer stricken. And his LDL was consistently low for 19 years!

The benchmark for the study was against those who never developed cancer. The exact level of LDL is not known since the slides for the presentation are not available. But the study's summary is available here.

http://www.cardiologytoday.com/view.aspx?rid=95943

This then raises a related, if uncomfotable, question. What if your LDL has been lowered because of statins? Aren't statins then responsible for the genesis of cancer (we already know it's implicated in IR)? At 19 years down the road, this would be some very slow "pathogenesis", though. But this seems very plausible, since popular statins like Zocor (simvastatin) have been around for more than 20 years.

Here's what the presenter (Paul M. Lavigne, MD, of Tufts Medical Center in Boston) said about statins: ???There is no evidence to indicate that lowering cholesterol with a medication in any way predisposes to a risk for cancer.???

How could he be sure? And what does the underlying data say: did those whose low LDLs were tracked for 19 years in the Framingham study take statins or not? You can tell a lot from what he said: he denied that there is any direct link between LDL-lowering statins and cancer. But notice what he didn't say: "it's possible that low LDLs achieved through statins may lead later to cancer development." No, he won't say that because that would be tantamount to biting the hand that feeds his sponsors. That would be my take on the wordsmithing engaged in by this researcher.

8508fec4bae4a580d1e1b807058fee8e

(6259)

on April 11, 2012
at 03:26 PM

PROSPER trial shows increased cancer "New cancer diagnoses were more frequent on pravastatin than on placebo".. http://www.ncbi.nlm.nih.gov/pubmed/12457784?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

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1 Answers

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8508fec4bae4a580d1e1b807058fee8e

on April 11, 2012
at 02:58 PM

I find it interesting that statins DO NOT REDUCE mortality in most people. In fact, statin users may not die from heart disease, but die from other causes - often cancer! Statins increase risk of diabetes for women, and guess what - diabetics age faster and are at higher risk for cancer! Warning: this is long but brings a lot of good points.

http://www.huffingtonpost.com/dr-mark-hyman/women-cholesterol-medication_b_1219496.html

Interesting excerpts:

"Statins have been proven to prevent second heart attacks, but not first heart attacks. Take it if you already have had one, but beware if your doctor recommends it for you if have never had a heart attack.

This current study adds to an increasing body of literature questioning the benefits of statins, while highlighting their potential risks.

In fact, based on this randomized controlled trial, estrogen replacement therapy, once considered the gold standard of medical care for the prevention of heart disease, was relegated to the trash bin of history joining medicine's many other fallen heroes including DES, Thalidomide, Vioxx, Avandia and more.

In this new study researchers reviewed the effect of statin prescriptions in a group of 153,840 women without diabetes and with an average age of 63.2 years. About 7 percent of women reported taking statin medication between 1993 and 1996. Today there are many, many more women taking statin medications, thus many more are at risk from harm from statins.

During the 3-year period of the study, 10,242 new cases were reported -- a whopping 71 percent increase in risk from women who didn't take statins. This association stayed strong at a 48 percent increased risk of getting diabetes, even after taking into account age, race/ethnicity, and weight or body mass index. These increases in disease risk were consistent for all statins on the market.

This effect also occurred in those with and without heart disease. Surprisingly, disease risk was worse in thin women. Minority women were also disproportionately affected. The risk of diabetes was 49 percent for white women, 57 percent for Hispanic women, and 78 percent for Asian women.

But in a typical "my mind's made up, don't confuse me with the facts" statement by the medical establishment, the researchers said we should not change our guidelines for statin use for the primary prevention of heart disease.

In a large meta-analysis published in the Lancet last year, scientists found that statins increased the risk of diabetes by 9 percent. If current guidelines were followed for those who should take statins, and people actually took them (thank God only 50 percent of prescriptions are ever filled by patients), there would be 3 million more diabetics in America. Oops. Other studies have recently called into question the belief that high cholesterol levels increase your risk of heart disease as you get older. For those over 85 it turns out having high cholesterol will protect you from dying from a heart attack and, in fact, from death from any cause.

Low Cholesterol May Kill You

A recent study showed that in healthy older persons, high cholesterol levels were associated with lower non-cardiovascular-related mortality. This is extremely concerning because millions of prescriptions are written every day to lower cholesterol in the older population, yet no association has been found between higher cholesterol and heart disease deaths for those aged 55 to 84; and for those over 85, the association seems to be inverse -- higher cholesterol predicts lower risk of death from heart disease.

The pharmaceutical industry, medical associations and academic researchers whose budgets are provided by grants from the pharmaceutical industry continue to preach the wonders of statins, but studies like these should have us look good and hard at our current practices. Are we doing more harm than good?

Cardiologists recommend putting statins in the water and giving them out at fast food restaurants and having them available over the counter. They believe in driving cholesterol as low as possible. Statin prescriptions are handed out with religious fervor, but do they work to prevent heart attacks and death if you haven't had a heart attack already? Bottom line: NO! If you want to learn why this is true, read on.

Statins Don't Work to Prevent First Heart Attacks

Recently, the Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death. In addition, many other studies support this and point out the frequent and significant side effects that come with taking these drugs. [1] If scientists found that drinking two glasses of water in the morning prevented heart attacks, even if the evidence was weak, we would jump on board. Big upside, no downside.

But this is not the case with statins. These drugs frequently cause muscle damage, muscle cramps, muscle weakness, muscle aches, exercise intolerance (even in the absence of pain and elevated CPK -- a muscle enzyme), sexual dysfunction, liver and nerve damage and other problems in 10-15 percent of patients who take them [2] [3]. They can also cause significant cellular, muscle and nerve injury as well as cell death in the ABSENCE of symptoms [4].

There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn't get the benefit of billions of dollars of marketing and advertising that statins do. One big trial was touted as proving statins work to prevent heart attacks, but the devil is in the details.

It was the JUPITER5 trial that showed that lowering LDL (or bad cholesterol) without a reduction in inflammation (measured by C-reactive protein) didn't prevent heart attacks or death [6]. Statins happen to reduce inflammation, so the study has been touted as proof of the effectiveness of these medications. Mind you it wasn't lowering the cholesterol that helped (which is the intended purpose of statins), but the fact that they lower inflammation. What is ignored by people who use this study to "prove" that statins work is the fact that there are so many better ways to lower inflammation than taking these drugs.

Yet other studies have shown no proven benefit for statins in healthy women with high cholesterol or in anyone over 69 years old [7] [8]. Some studies even show that aggressive lowering of cholesterol can cause MORE heart disease. The ENHANCE trial showed that aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more arterial plaque and no fewer heart attacks [9].

Other research calls into question our focus on LDL or the bad cholesterol. We focus on it because we have good drugs to lower it, but it may not be the real problem. The real problem is low HDL that is caused by insulin resistance (diabesity). In fact, studies show that if you lower the bad (LDL) cholesterol in people with low HDL (good cholesterol) that is a marker of diabesity -- the continuum of obesity, prediabetes and diabetes -- there's no benefit [10].

Most people simply ignore the fact that 50-75 percent of people who have heart attacks have normal cholesterol [11]. The Honolulu Heart Study showed older patients with lower cholesterol have higher risks of death than those with higher cholesterol [12].

Some patients with multiple risk factors, or who have had previous heart attacks do benefit, but when you look closely the results are underwhelming. It's all in how you spin the numbers. For high-risk males (those who are overweight and have high blood pressure, diabetes, and/or a family history of heart attacks) and are younger than 69 there is some evidence of benefit, but 100 men would need to be treated to prevent just one heart attack. That means that 99 out of 100 men who take the drug receive no benefit. Drug ads say the risk is reduced by 33 percent. Sounds good, but that just means the risk of getting a heart attack goes down from 3 percent to 2 percent.

Despite the extensive data showing that statins are a questionable therapy at best, they are still the No. 1 selling drug in the U.S. What isn't so well known is that 75 percent of statin prescriptions are written for people who will receive no proven benefit. The cost of these prescriptions? Over $20 billion a year. Yet somehow the 2004 National Cholesterol Education Program guidelines expanded the previous guidelines to recommend that even more people without heart disease take statins (from 13 million to 40 million) [13]. What are we thinking?

Why would respected scientists go against the overwhelming research that statins don't prevent heart disease in people who haven't already had a heart attack? You can find the answer if you follow the money. Eight of the nine experts on the panel who developed these guidelines had financial ties to the drug industry. Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak.

What Should Women Do? It is time to push the sacred cow of statins overboard. But first let me say this. If you have had a heart attack, or have heart disease, the evidence shows they do in fact help protect against a second heart attack, so keep taking them.

However, you should be aware that most prescriptions for statins are given to healthy people whose cholesterol is a little high. For these folks the risk clearly outweighs the benefit. The editorial that accompanies the recent study on women taking cholesterol-lowering medication that I opened this article with was quite clear. Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has "important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality." In plain English, she said that we shouldn't be using statin drugs for women without heart disease because:

1) The evidence shows they don't work to prevent heart attacks if you never had one.

2) They significantly increase the risk of diabetes.

Treating risk factors like high cholesterol is misguided. We must treat causes -- what we eat, how much we exercise, how we handle stress, our social connections and environmental toxins are all more powerfully linked to creating health and preventing disease than any drug on the market. Remember what you put at the end of your fork is more powerful than anything you will ever find at the bottom of a pill bottle.

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