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The big cure-all unmasked

MagazineApril 2009 (Vol. 20 Issue 1)The big cure-all unmasked

Statins, the gold standard of cholesterol treatment, have become the liver tonic of the modern age

Statins, the gold standard of cholesterol treatment, have become the liver tonic of the modern age. Doctors hand them out for everything from osteoporosis to senile dementia, as early studies suggest that they may have preventative effects.

When early laboratory evidence showed that statins induce apoptosis (cell death) and reduce prostate cancer cell growth and spreading (Cancer Epidemiol Biomarkers Prev, 2008; 17: 88-94), medicine concluded that statins were a potent cancer preven-tative (J Natl Cancer Inst, 2006; 98: 1819-25). Early studies bolstered this view, offering preliminary evidence that long-term statin use could prevent cancers of the breast, prostate, blood and colon.

Studies of populations with prostate cancer found links between statins and the prevention of more advanced forms of the disease (Curr Opin Urol, 2008; 18: 333-9). Doctors were particularly enthusiastic when a case-control study found a cancer risk reduction of 20 per cent with statins (J Clin Oncol, 2004; 22: 2388-94).

Now, that reputation-that statins are a powerful cancer preventative-has been sullied with the latest findings that statins may actually cause prostate cancer in overweight men. Researchers at the Fred Hutch-inson Cancer Research Center in Seattle, WA, discovered the link while studying more than 1000 cases of prostate cancer, diagnosed between 2002-2005, compared with a similar number of age-matched controls.

Although there was no risk of developing the disease in normal- weight statin users, including those who had taken the drugs for more than 10 years, overweight men- those with a body mass index of more than 30 kg/m2-increased their risk by 1.5 times over overweight non-users. Also, the risk increased to 1.8 times with statin use for five or more years (Am J Epidemiol, 2008; 168: 250-60).

But the Seattle evidence is only the latest to challenge the myth of cancer prevention. A University of Athens review of 19 epidemiological studies found no evidence of a protective effect with statins and even suggested that the earlier evidence of lowered risk was just coincidental (Int J Cancer, 2008; 123: 899-904).

More detailed analyses found a lower incidence of advanced cancer, but no reduction in the risk of overall prostate cancer (Curr Opin Urol, 2008; 18: 333-9). An even larger meta-analysis of 35 randomized controlled trials showed a link between the drug and developing cancer, depending on the patient's age: the older the man, the more likely he was to develop cancer (J Clin Oncol, 2006; 24: 4808-17).

Another meta-analysis of prava-statin in elderly patients confirmed an association between the drug and an increased risk of cancer with increasing age (CMAJ, 2007; 176: 649-54).

As for other forms of cancer, the Department of Pharmacology team at the University of Athens School of Medicine has systematically examined and combined all the evidence of statin use and cancer incidence. Their review of 14 studies found no evidence to support claims that statin use can protect against malignancies of the blood, such as leukaemia (Br J Clin Pharmacol, 2007; 64: 255-62).

They also found no evidence that statins can significantly reduce the risk of colorectal cancer, although they concluded that there might be some effect with higher doses (J Clin Oncol, 2007; 25: 3462-8). The same methodology also found no evidence that statins can reduce the risk of either pancreatic or breast cancers (Am J Gastroenterol, 2008; 103: 2646-51; J Clin Oncol, 2005; 23: 8606-12).

Yet another research team, from the Department of Epidemiology and Survellance Research at the Ameri-can Cancer Society, found that neither short- or long-term (five years or more) use of the drug prevented colorectal cancer (J Natl Cancer Inst, 2006; 98: 69-72).

Similarly, a Boston University study of more than 3600 patients in Massachusetts could also find no protective effect other than a lower risk of stage IV (advanced, metas-tasizing) cancer among statin users, an association that the authors believe requires confirmation (J Natl Cancer Inst, 2007; 99: 32-40).

The final blow was dealt by a University of Connecticut School of Pharmacy meta-analyses of nearly 90,000 participants involved in all studies claiming a protective effect against all cancers. Again, the data indicate that no type of cancer is affected by statin use (JAMA, 2006; 295: 74-80).

Aside from the damning evidence against its role as a cancer preventative, the latest evidence also shows that statins don't prevent fractures or type 2 diabetes either (Pharmacoepidemiol Drug Saf, 2007; 16: 627-40; Curr Med Res Opin, 2008; 24: 1359-62). This kicks away several plat-forms on which the drug's reputation as a preventative treatment has been based.

Lynne McTaggart

Take as little as possible

If you must take a statin drug, take the smallest dose possible. New evidence shows that even the minimum daily dose of 20 mg/day causes potentially fatal muscle pain and weakness-and may even lead to complete breakdown of muscle tissue (N Engl J Med, 2008; 359: 789-99). Higher doses or taking the drug with other drugs had a magnifying effect, causing a far higher incidence of myopathy than the official figures claim. The latest evidence shows that as much as 1.6 per cent of patients develop muscle weakness-that's 128,000 patients in the US alone.


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