Ravnskov on statins, prevention, and cancer

Uffe Ravnskov, a doctor who has written extensively about the falsity of the cholesterol hypothesis, writes in the BMJ on statins.

In their paper Ebrahim et al refer to the 2013 Cochrane report as an argument for primary prevention with statins. The fact is that no such trial has succeeded in prolonging the life of the participants and this is also what can be deducted from the meta-analysis by the Cholesterol Treatment Trialists (CTT) Collaboration. From table 3 it is possible to calculate that the chance to be alive after five years for people without vascular disease and whose 5-year risk of a major vascular event is lower than 10% is the same, whether they are on statin treatment or not and whether they have a vascular disease or not.

There is a benefit for people whose risk lies between 10% and 20%, but it is trivial at most. According to the table their chance of being alive after five years without treatment is 89.9%. If they take a statin every day they can increase their chance to 90.7%. …

Several case-control studies are in accord. In a study by Iwata et al. 13.3% of patients with lymphoid malignancies had been treated with statins compared with 7.3% of control individuals with non-malignant diseases matched for age and sex (p<0.001). In a retrospective study of 388 men with prostate cancer and 1552 matched controls Chang et al. found an increasing cancer risk with increasing cumulative statin dose (x2 for linear trend 7.23; p=0.007). In a study by Agalliou et al. obese men taking statins had an increased risk of prostate cancer compared with obese non-users (OR = 1.5, 95% CI 1.0–2.2), with a stronger association for long-term use (OR = 1.8, 95% CI 1.1–3.0). In a retrospective analysis by Ritch et al., those on statins among 1261 patients who had undergone radical prostatectomy were more likely to have an elevation of biochemical tests that suggested recurrent cancer (p<0.05), and also a more aggressive cancer type reflected as a higher Gleason sum (p<0.05). Finally, Hoffman et al. found that of 83 patients with bladder cancer, the tumor became more aggressive in 53% of those who took statins, in contrast to only 18% for non-users (p=0.004) (1). The reason why statin treatment may result in cancer is probably not an effect of the drug, but that low cholesterol predisposes to cancer. Thus, nine cohort studies including more than 140 000 individuals found that cancer was inversely associated with cholesterol measured 10–30 years earlier, and the association persisted after exclusion of cancer cases appearing during the first 4 year (1)

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