Monday, August 25, 2008


Since the haydays of statins, I have always been suspicious of lowering LDL-C too much. Initially, in the early 90s, we were advised to lower LDL-C to 100mg/dl. Later in the early 2000s and especially with the release of the TNT results, we were advised to lower the LDL-C to 75-80mg/dl, with the super statins. Undoubtedly, the pharmas would wish us to use more statins to lower the LDL-C more. I was very weary of this and had gone against clinical practice guidelines to maintain my patient's LDL-C at about 100mg/dl. I was worried that too lower an LDL-C would increase the chance of getting a cancer, as we need a certain level of LDL-C for proper and orderly cellular growth. Well, many studies concluded by assuring us that I was wrong and that there were no increase risk of cancers with the further lowering of LDL-C.
A few months ago, with the release SEAS, we got the early hints that there may be an association of cancers with LDL-C lowering. Now with the release of a statistical reanalysis of some of the major statin trials, involving a total of almost 95,000 patients, a study led by Dr R Karas, and Dr ASheik-Ali, it was concluded that there may in fact be a real association of cancers with LDL-C. They were fairly certain that the incidence of cancers were not associated with statins use, but rather with LDL-C levels. In fact they worked out that there maybe a 2.2% increase in cancer risk for every 10mg/dl reduction of LDL-C. Very interesting.
They did raise the possibility, that since many of the studies were over 5years, they were not sure, if the cancers had been present in some of the patients, and that cause the low LDL-C in the first place, or that these patients really developed cancers as a result of the low LDL-C. It is almost like a "chicken or egg " situation. Very interesting.
I expect that over the rest of the year, there will be more and more re-analysis of many of the statins study, to see if there is really an association of cancers with low LDL-C. After all, we cannot justify, trying to prevent CAD with LDL-C lowering, and in exchange, giving our patients cancers. Interesting. This column surely merits a close watch.

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