Statins, low-density lipoprotein cholesterol, and risk of cancer.
OBJECTIVE
We sought to assess whether statin-mediated reductions in low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of cancer.


BACKGROUND
We recently reported an inverse association between on-treatment LDL-C levels and incident cancer in statin-treated patients enrolled in large randomized controlled trials, raising concern that LDL-C lowering by statins may increase cancer risk. However, meta-analyses suggest a neutral overall effect of statins on incident cancer.


METHODS
A systematic literature search identified 15 eligible randomized controlled trials of statins with >or=1,000 person-years of follow-up that provided on-treatment LDL-C levels and rates of incident cancers (19 statin and 14 control arms, 437,017 person-years cumulative follow-up, and 5,752 incident cancers).


RESULTS
In the statin arms, meta-regression analysis demonstrated an inverse association between on-treatment LDL-C and incident cancer, with an excess of 2.2 (95% confidence interval: 0.7 to 3.6) cancers per 1,000 person-years for every 10 mg/dl decrement in on-treatment LDL-C (p=0.006). The corresponding difference among control arms was 1.2 (95% confidence interval: -0.2 to 2.7, p=0.09). Compared with the control arms, the statin regression line was significantly shifted leftward, such that similar rates of incident cancer were associated with lower on-treatment LDL-C (p<0.05). Meta-regression demonstrated that statins lack an effect on cancer risk across all levels of on-treatment LDL-C.


CONCLUSIONS
There is an inverse association between on-treatment LDL-C and incident cancer. However, statins, despite producing marked reductions in LDL-C, are not associated with an increased risk of cancer.
Alsheikh-Ali
Alawi A
AA
Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Trikalinos
Thomas A
TA
Kent
David M
DM
Karas
Richard H
RH
D008078:Cholesterol, LDL / Q000097:blood*; D015986:Confounding Factors, Epidemiologic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D015994:Incidence; D009369:Neoplasms / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors