Tuesday, July 21, 2009

9. Do Statins Cause Cancer?

A person on statin drugs has enjoyed the protective benefit of high cholesterol all his life, up until the time he was treated with the drug. Cancer takes a long time to develop to a level where it can be detected, and the effect of depleted cholesterol on vitamin D supply also takes time to become a problem, due to the body's ability to store both vitamin D and cholesterol in the skin. Even controlled clinical trials are never conducted over a long enough time period to pick up on the slow erosion of cancer protection consequent to sustained statin usage.

Perhaps the first time alarm bells started to go off in the general public on the idea that statin drugs might cause cancer was when the results of the Vytorin study finally came out, and showed that there was a statistically significant 64% increase in all types of cancer among those who took Vytorin, as contrasted with the placebo group. A scathing review of the situation has been written by Bryan Richards of CNN:

"The only surprise about the cancer data is that it was reported at all. Normally Big Pharma would have swept such incriminating data under the rug. The reason they couldn't is because all their Vytorin data is now under such scrutiny they can't dispose or alter undesirable data like they normally do."

"This cancer information has very broad implications for the entire statin industry -- indicating that as cholesterol levels are forced abnormally low under the pretense of heart disease prevention, cancer rates are going to rise. Any fleeting benefits to high dose statin therapy or other means of aggressively and unnaturally lowering cholesterol are rapidly disappearing." (Vytorin Causes Cancer) .

Vytorin is actually a trade name for a pill that combines two cholesterol reducing drugs, Zetia (ezetimibe) and Zocor (simvastatin), into a single pill, to achieve a remarkably greater drop in cholesterol levels than those realized by people taking Zocor operating alone. In fact, after eight weeks of treatment, average LDL levels had been driven down to just 52 mg/LDL in the people taking Vytorin. (Very Low LDL with Vytorin) . The increased incidence in cancer was significant at the 95% level, meaning that there is only a 5% chance that the result was a chance occurrence.

For at least two types of cancer, an increased risk due to statin exposure has been demonstrated, non-melanoma skin cancer and liver cancer. Liver cancer is no surprise, since one of the severe side effects of statin exposure is liver damage. The liver is the "control center" for cholesterol, the place where cholesterol is manufactured and broken down. Skin cancer is a direct consequence of sun exposure. However, vitamin D, which is protective against all cancers, is manufactured in the skin, and immediately made available to the epithelial cells to protect them from cancer. A depleted supply of cholesterol due to statin exposure interferes with the ability to produce vitamin D and thus foils this protective response.

In a study conducted at the University of California at San Francisco, statins were shown to cause liver cancer in rodents. Again, this article has been kept under wraps by Big Pharma, but was picked up by statin skeptics and posted on the Web. By contrast, this cancer-causing effect was notably not found for drugs that lower blood pressure.

"All members of the two most popular classes of lipid-lowering drugs (the fibrates and the statins) cause cancer in rodents, in some cases at levels of animal exposure close to those prescribed to humans." (Statins and Liver Cancer) .

The observation of increased risk of non-melanoma skin cancer, of course, has been kept in the back room by Big Pharma, but was picked up by one of the most vocal and convincing skeptics of the benefits of statin therapy, Dr.Ravnskov, the Director of THINCS, the "International Network of Cholesterol Skeptics." (Statins and Non-Melanoma Skin Cancer) .

In the Heart Protection Study, there was an increase in non-melanoma skin cancer observed in people treated with simvastatin, but, with a significance value of p = 0.06, it barely missed the significance level cutoff of 0.05. However, by combining these results with those of another study of simvastatin, the p value becomes 0.028, well within the range of significance. Such a technique of combining the results of multiple trials to gain significance is a perfectly legitimate scientific method.

But what about prostate cancer? It took a lot of digging on the Web to finally obtain a full and rational explanation for the various pieces of the puzzle, but the final full story that emerges leads to the likely conclusion that statins increase risk to prostate cancer, at least for those whose LDL levels are driven below 70 mg/dl. The document that is central to the argument that follows is a book chapter written by the Harvard urologist, Dr. Abraham Morgentaler, and reprinted in full here [19]: (Testosterone and Cancer) . A shorter version of the story can be found here: (Short Version) . His chapter is fascinating and extremely well written, and it describes how he ultimately came to believe that a "fact" that he had been taught long ago in medical school was actually a myth. He wrote in the introduction:

"How the original fear about T [testosterone] and prostate cancer came to be is a fantastic story involving Nobel Prize winners, medical breakthroughs, and a critical paradox that took two-thirds of a century to solve. In the end, it is also a cautionary tale of how it may take years -- even decades -- to correct a medical 'truth' once it has been established."

It was through the practice of treating patients with naturally low testosterone who complained of sexual dysfunction that Dr. Morgentaler eventually discovered that what he had long ago been taught in medical school was in fact the exact opposite of the truth. Not only does a high testosterone level not cause or fuel prostate cancer, but, in fact, a low testosterone level increases susceptibility to prostate cancer. He discovered this because he thought testosterone supplements would help his patients' symptoms, but was afraid to give testosterone to anyone who might have prostate cancer. Because of this concern, he decided to test his patients for prostate cancer, to ensure that any who already had cancer would not be given the treatment. Much to his surprise, he found that a much larger than typical percentage of his patients had prostate cancer [18]. Despite the fact that their PSA level was below 4.0 ng/mL, their cancer incidence was an astounding 15%.

He wrote:
"The way I look at these numbers is that men with low testosterone have a cancer rate as high as men with normal T who are a decade older."

And he continues with this comment that makes it quite conclusive that it is the low testosterone that causes the increased risk:

"More importantly, in our study of 345 men, we found that the degree of testosterone deficiency correlated with the degree of cancer risk. Men whose testosterone levels were in the bottom third of the group were twice as likely to have cancer diagnosed on biopsy as men in the upper third. This finding adds to the concern that low testosterone is a risk factor for prostate cancer."

Now we can look back on the studies that suggest that statins protect from prostate cancer in a new light. Since low cholesterol and low testosterone go together, it is logical that high cholesterol and high testosterone do too. People who are prescribed statins have enjoyed a natural protection against prostate cancer all their lives, due to their elevated cholesterol levels. This inate advantage is what causes the statistics to show that statin users have a lower incidence of prostate cancer. Statin drugs are fast eroding this advantage, however. And when statin drugs drive cholesterol to the below 70 mg/dl mark, they are likely leaving the patient extremely vulnerable to prostate cancer.

A recent study published in 2008 in the American Journal of Epidemiology [1] (Statins Increase Risk for Prostate Cancer) bears out my prediction that men taking statins would have an increased risk to prostate cancer when compared against other men who are the same age. The authors conducted a population-based study of 1001 prostate cancer cases diagnosed between 2002 and 2005, and 942 age-matched controls. They were expecting to find that statins protect against cancer, but no evidence of such protection emerged from the study. Instead, they found that, for obese men, statins lead to a statistically significant increase in risk. They observed a 50% increase in risk overall, and a significantly larger 80% risk for those who had taken statins for at least five years.

Another indicator that statins may increase risk is based on the inicidence of prostate cancer worldwide. In fact, the rate of prostate cancer is much higher in the West than in the East. For example, blacks in the U.S. have 60 times the incidence of prostate cancer compared to men in Shanghai, China (Prostate Cancer Statistics) . The U.S. has the dubious distinction of having the highest prostate cancer incidence worldwide, with European rates being somewhat lower, and prostate cancer rates among Asians sharply lower.

In summary, while the statin manufacturers would like you to believe that statins are protective against cancer, it has been shown conclusively that this is not true. To the contrary, there is considerable evidence that statins contribute to an increased risk of cancer, in at least three categories: liver cancer, nonmelanoma skin cancer, and prostate cancer.


Unknown said...

Wow I had no idea that Low Testosterone was a risk factor for cancer. I guess I am thankful for my husbands balding head, and hairy shoulders!

crandreww said...

Thank you so much for helping this RX addicted world to get some "real" information...

As a former Critical Care Rn, Disabled by Lipitor...I am happy to see research scientists with the balls to come forward and get the truth out!

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