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J Am Coll Cardiol, 2008; 51:90-91, doi:10.1016/j.jacc.2007.08.054
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Age Predicts Cancer Incidence Better Than Statin-Induced Low-Density Lipoprotein Level

Christopher M. Rembold, MD*

* Cardiovascular Division, University of Virginia Health System, Box 800146 Health System, Charlottesville, Virginia 22908 (Email: crembold{at}virginia.edu).

I disagree with the data analysis in the recently published article in the Journal suggesting an association between lower statin-induced low-density lipoprotein (LDL) levels and increased incidence of cancer (1). My analysis of the 8 larger and longer trials (>3 years and >1,000 patients) suggests a clear association between increasing age and increased incidence of cancer (Fig. 1) (r2 = 0.77, p = 0.004, regression not corrected for study size). Age is a known and biologically plausible risk factor for cancer. Multivariate linear regression resulted in the following model:

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  		Figure 1 Dependence of Yearly Cancer Incidence on Age in Patients Treated With Statins

Cancer incidence was calculated from data provided in Alsheikh-Ali et al. (1). AFCAPS = Air Force Texas Coronary Atherosclerosis Prevention Study; ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; CARE = Cardiac Angiography in REnally impaired patients; HPS = Medical Research Council/British Heart Foundation Heart Protection Study; LIPID = Long-Term Intervention With Pravastatin in Ischemic Disease Trial; PROSPER = Prospective Study of Pravastatin in the Elderly at Risk; WOS = West of Scotland trial; 4S = Scandinavian Simvastatin Survival Study.

 
The overall model was significant with r2 = 0.83 and p = 0.013. The multivariate p value for the coefficient of age (p = 0.055) was nearly statistically significant and lower than the multivariate p value for the coefficient of LDL on treatment (p = 0.26). This model suggests that age is more predictive of cancer incidence than LDL on treatment. Based on this analysis, we should reconsider the assertion that statin-induced lowering of LDL is associated with increased cancer incidence.


   Footnotes
 
Please note: Dr. Rembold has received honoraria for lectures on dyslipidemia from Kos Pharmaceuticals, Abbott, AstraZeneca, Merck, Schering-Plough, and Pfizer.


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  1. Alsheikh-Ali AA, Maddukuri PV, Han H, Karas RH. Effect of the magnitude of lipid lowering on risk of elevated liver enzymes, rhabdomyolysis, and cancer J Am Coll Cardiol 2007;50:409-418.[Abstract/Free Full Text]

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Alawi A. Alsheikh-Ali and Richard H. Karas
J. Am. Coll. Cardiol. 2008 51: 92. [Full Text] [PDF]




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