Is there any evidence that the use of lipid-lowering drugs would be associated with an increased ri

Fråga: Is there any evidence that the use of lipid-lowering drugs would be associated with an increased risk of cancer?

Sammanfattning: There is no convincing or conclusive evidence that the use of lipid-lowering drugs would be associated with an increased risk of malignancy.

Svar: The issues of lipid-lowering drugs and risk of cancer have been extensively discussed in the literature during the last years (1,2). Newman and Hulley (1) reviewed epidemiological studies of cancer and cholesterol levels, clinical trials of cholesterol lowering, and animal data on cancerogenicity of lipid-lowering drugs. They concluded that all members of the two most widely used classes of lipid-lowering drugs (fibrates and statins) cause cancer in rodents, in some cases at doses close to those prescribed to humans, but that evidence of carcinogenicity of these drugs from clinical trials in humans are inconclusive. Dalen and Dalton (2) challenge the interpretation and conclusions of paper (1) and state that very low levels of cholesterol (< 4.14 mmol/l) as such have been associated with an increased risk of cancer (3). The risk of cancer is greatest in the two years following the detection of the low cholesterol levels which are almost certainly due to the cancer rather than the converse. In the Multiple Risk Factor Intervention Trial (4), serial cholesterol measurements demonstrated that cholesterol levels decrease in the two years before the diagnosis of cancer.

Concerning the slightly increased relative risk of cancer death reported in some clinical trials, Dalen and Dalton cite three meta-analyses (3,5,6) which showed an almost identical increase in cancer deaths in dietary intervention studies as in drug intervention trials. They also interpret the rodent carcinogenicity data quite diffirently than Newton and Hulley, the doses used in rodent studies being substantially higher than the recommended maximum dosage for humans (2).

Interestingly, it has also been discussed whether the use of HMG-CoA inhibitors would inhibit carcinogenesis and malignant cell growth by inhibiting the availability and/or synthesis of cholesterol, essential for tumour growth (7).