According to the international Cholesterol Treatment Trialists’ Collaboration, based on data from more than 166,000 clinical trial participants, there is no evidence whatsoever that statin therapy either causes or prevents cancer. Whether this really is the “last word” on this topic (as suggested in a report yesterday on MedPage Today) is debatable, however.
Apparently, a representative of the Cholesterol Treatment Trialists’ Collaboration will present findings next week (at the annual congress of the European Society of Cardiology in Stockholm) that are based on a meta-analysis of data from 25 large, randomized, controlled clinical trials of several statins over periods lasting for up to 10 years.
Information released prior to the presentation has suggested that:
- There were no significant differences in the incidence or the rate of cancer mortality between patients in the treatment arms and the control arms of the trials at 5 years of follow-up.
- In these 25 trials, a total of 9,954 participants developed cancer and 3,498 died from their cancer.
Twenty of the 25 randomized, controlled trials compared a statin to a placebo. In these 20 trials:
- Cancer incidence in the treatment arms was 3,502 versus 3,514 cases in the control arms (1.4 percent per year for both arms), for a rate ratio of 0.99.
- There were 1,289 deaths among those taking statins versus 1,281 in those getting the placebo (0.5 percent per year for both arms), for a rate ratio of 1.00.
The remaining five randomized, controlled trials compared higher and lower doses of specific statins. In these five trials:
- Cancer incidence in the higher dose arms was 1,466 versus 1,472 in the lower dose arms (1.6 percent per year for both arms), for a rate ratio of 1.02.
- There were 447 deaths in the higher dose arms versus 481 in the lower dose arms (0.5 percent per year for both arms), for a rate ratio of 0.88.
Finally, with regard to effects related to specific types of cancer, as opposed to cancer overall:
- There was no evidence of any effect of statin therapy on cancer incidence or mortality at any particular site, with increasing years of treatment, or in any particular subgroup.
According to Johnathon Emberson, PhD, who will present the study data in Stockholm, the collaborative study group planned the prospective accumulation of data on cancer mortality from an early stage in order to address early observational studies suggesting that lowering cholesterol levels might raise risk for cancer. The data they collected have allowed them to go back to individual, patient-level data from all 25 studies in order to carry out the meta-analysis. This is not always possible for multi-study meta-analyses, and this does add to the rigor of the current report.
Emberson has acknowledged that the study data only covers 5 years of treatment. He notes that an effect might still occur after longer periods of statin therapy. However, some of the studies included in this meta-analysis have 10 years worth of data and there is still no evidence of a long-term effect in these studies.
The good news is therefore that statin therapy does not seem to carry any increase in risk for any type of cancer. The bad news is that, if these data are correct, statin therapy may have no real preventive or therapeutic affect on prostate cancer.
It may take a while to see if the data from this trial actually “kills off” the idea that statin therapy may have beneficial impact in prevention and/or treatment of prostate cancer. Our suspicion is that studies will continue for a significant time yet.
Filed under: Management, Prevention, Treatment, Uncategorized Tagged: | Prevention, risk, statin, Treatment
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