The Pharmaceutical Journal
Vol 279 No 7463 p122
4 August 2007

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Low levels of LDL cholesterol associated with increased cancer risk

Evidence for an association between low levels of low-density lipoprotein cholesterol (LDL-C) and increased cancer risk is published this week in the Journal of the American College of Cardiology (2007;50:409). However, the researchers emphasise that the relationship does not imply causality but is hypothesis-generating and requires further investigation.

The researchers analysed summary data from 23 statin treatment arms with 309,506 person years of follow-up and found an inverse relationship between cancer incidence and achieved LDL-C levels (P=0.009). No such correlation was found with percentage or absolute reduction in LDL-C.

The researchers also looked at the relationship between magnitude of LDL-C lowering and rates of elevated liver enzymes and rhabdomyolysis but found no association in either case. A positive relationship between higher statin dose and higher rates of elevated liver enzymes (P<0.001) was found.

The researchers highlight that a more detailed analysis using individual patient data from all the trials may yield different results. However, they conclude that their findings suggest the risk of statin-associated liver enzyme elevations or muscle injury is not related to the magnitude of LDL-C lowering but is more likely to be determined by drug and dose specific effects.

“Furthermore, a concerning inverse relationship between achieved LDL-C levels in statin-treated patients and risk of cancer was observed, and requires further investigation,” they add.

The author of an accompanying editorial (ibid p419) says that, although provocative, the findings provide insufficient evidence that there is any problem with LDL-C lowering that outweighs its significant benefits on vascular disease.