Wednesday, September 01, 2010


This question again came up at the concluding ESC 2010 ( European Society of Cardiology Congress 2010 ) at Stockholm. The UK cardiologist have formed a Cholesterol Trialist Collaboration group, much like the anti-platelet trialist collaboration group and the aspirin trialist collaboration group. Led by Dr Jonathan Emberson of Oxford U-UK, the CTT group meta-analysed 21 clinical trials on Statins and heart disease, involving 130,000 patients. There was also a separate meta-analysis performed on a further 5 studies involving 40,000 patients comparing different statin doses and heart disease. Although these studies were all not primarily statins and cancer studies, the collaborators were hoping to see if people taking statins had a higher incidence of cancers went compared to placebo, at least up to 5 years follow-up.
Well the findings were that, taking statins did not put one at risk of cancers, up to 5 years. Low LDL-C did not put one at risk and the risk of cancers were also not dose related.
That is all well and good. Except that the data is up to 5 years. What happens after that? I suppose we are quite sure that statins does not cause cancers. What we are perhaps not so sure about is whether taking cancer puts one at long term risk.
Cancer is a rather complex disease. It can involve so many different organs with so many different outcomes. It is unlikely to be uni-factorial. More likely multi-factorial. Does taking statins, and having a super-low LDL-C, predispose one to the risk of cancers. Will statins, or super-low LDL-C, alter the cell structures, or alter the immune system, in such a way as to alter the triggers of programmed cell death ( apoptosis ), or does it affect the telomeres of the cells, all these after more then 5 years of course.
Looks like the data to 5 years of statins, is good. Statins is quite safe. More then 5 years, lets see? I am sure that the CTT group will be following up the cohort and will be reporting to us again.
Whatever it may reveal later, the saying is true, " Only take medications when the benefit outweights the risk, or potential risk ". No one should take any medication " just for the fun of it ". We never know what can happen 20-30 years down the road. This strategy, to drive LDL-C as low as possible, has some meager benefit, but does it outweight the risk? at the moment, only God knows.

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