Non-coronary heart disease mortality and risk of fatal cancer in patients with treated heterozygous familial hypercholesterolaemia: a prospective registry study.
BACKGROUND
The prognosis from coronary heart disease (CHD) for patients with heterozygous familial hypercholesterolaemia has improved substantially since the introduction of HMG Co-A reductase inhibitors (statins), but the effect of lipid-lowering drug therapy combined with dietary and life style advice on non-coronary mortality and the risk of fatal cancer is unclear.


METHODS
The cohort of 2871 patients was recruited from 21 outpatient lipid clinics in the UK from 1980 to 1998 and was followed for 22,992 person-years. The standardised mortality ratio (SMR) was calculated from the ratio of the number of deaths observed to the number expected in the general population of England and Wales.


RESULTS
There were 169 deaths, including 102 (60.4%) from CHD, and 32 (18.9%) from cancer. The SMR for CHD was 2.5-fold higher than in the general population (95% CI 2.1, 3.1), but the all-cause SMR was not increased (1.1, 95% CI 0.9, 1.3) and non-coronary mortality was significantly lower in men (0.5, 95% CI 0.3, 0.7) and women (0.6, 95% CI 0.4, 0.9). The SMR for all cancers was significantly reduced (0.6, 95% CI 0.4, 0.8) with an 80% reduction in fatal cancers of the respiratory and intra-thoracic organs and a non-significant reduction in fatal cancers of the genitourinary and digestive organs.


CONCLUSIONS
Although the study cannot exclude the possibility that statins have anti-cancer activity, the results strongly suggest that giving advice to consume a healthy diet, increase physical activity and stop smoking is associated with a substantial reduction in mortality from cancer.
Neil
H A W
HA
Division Public Health and Primary Health Care, University of Oxford, Oxford OX3 7LF, UK.
Hawkins
M M
MM
Durrington
P N
PN
Betteridge
D J
DJ
Capps
N E
NE
Humphries
S E
SE
D000328:Adult; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D004032:Diet; D004739:England / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000235:genetics; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D014852:Wales / Q000453:epidemiology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors