Letter to the Editor
Is Cholesterol Lowering with Statins the Gold Standard for Treating Patients with Cardiovascular Risk and Disease?
Abstract
In his excellent editorial on statins, Dr. Sinatra1 touched on the issue of carcinogenicity related to these medications. He noted the association between lipid-lowering drugs and carcinogenicity in rodents, and he mentioned the increased rate of breast cancer reported in the Cholesterol and Recurrent Events Trial (CARE) of postmenopausal U.S. women using statins. 2,3 Although the results of the Scandinavian Simvastatin Survival Study (4S),4 with its 7-year follow-up, are reassuring in terms of statin cancer risk,1 the results of other recent studies are more disturbing. The Prospective Study of Pravastatin in the Elderly at Risk study,5 conducted in Scotland, noted an increased rate of solid tumors in elderly patients treated with pravastatin, and a study performed in Japan found an increased rate of lymphomas in patients using statins.6 The latter finding is particularly unsettling, because statins are known to inhibit tumor necrosis factor-,7 and targeted tumor necrosis factor- inhibitors have been associated with the development of lymphoma.8 Dr. Sinatra1 estimated that as many as 36 million Americans could eventually be prescribed statin therapy according to current guidelines. Until the carcinogenicity of statins can be defined better, the use of these widely prescribed—probably overprescribed— medications should be limited, and other methods of cardiovascular disease reduction such as diet, exercise, and -3 fatty acid supplementation should be pursued vigorously.Raphael B. Stricker, MD
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References
1. Sinatra ST. Is cholesterol lowering with statins the gold standard for treating patients with cardiovascular risk and disease? South Med J 2003; 96: 220–222(editorial).
2. Sacks FM, Pfeffer MA, Moye L, et al. Rationale and design of a secondary prevention trial of lowering normal plasma cholesterol levels after acute myocardial infarction: The Cholesterol and Recurrent Events Trial (CARE). Am J Cardiol 1991; 68: 1436–1446.
3. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–1009.
4. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–1389.
5. Shepherd J, Blauw GJ, Murphy MB, et al; PROSPER study group. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial—PROspective Study of Pravastatin in the Elderly at Risk. Lancet 2002; 360: 1623–1630.
6. Murashige N, Hiroshi I, Matsuo K, et al. Increased incidence of lymphoid malignancies in patients receiving statins (HMG-CoA reductase inhibitors): A case-control study involving 1102 patients. Blood 2002; 100: 467a.
7. Solheim S, Seljeflot I, Arnesen H, et al. Reduced levels of TNF α in hypercholesterolemic individuals after treatment with pravastatin for 8 weeks. Atherosclerosis 2001; 157: 411–415.
8. Brown SL, Greene MH, Gershon SK, et al. Tumor necrosis factor antagonist therapy and lymphoma development: Twenty-six cases reported to the Food and Drug Administration. Arthritis Rheum 2002; 46: 3151–3158.
