Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Low Cholesterol And Cancer Risk

A provocative press release crossed my desk today, “Study Finds Association Between Low Cholesterol Levels and Cancer” with subtitle: “Benefits of Statin Therapy Outweigh Small Risk.”  Well that’s fairly terrifying, isn’t it?  It sounds as if they’re saying that taking a statin (like lipitor or zocor) is good for your heart but might carry with it the “small” risk of developing cancer.

First of all, let me assure you that this is a gross misinterpretation of the metanalysis.  The authors themselves never postulated a cause and effect between statins and cancer, and in fact did all they could to avoid drawing this conclusion.  They merely observed that there was a slight trend towards higher cancer rates among people with low LDL cholesterol.

There are two very good explanations for the higher cancer rates in people with low cholesterol:

1. Everyone knows that “unexplained weight loss” is an ominous sign.  Often times a patient’s first clue that they have cancer is sudden weight loss – since cancer has a voracious appetite and steals nutrients from the rest of the body.  When people lose weight, their cholesterols decrease.  So it’s possible that low LDL cholesterol is really just a surrogate marker for those who already have very early stages of cancer that have not yet been detected otherwise.

2.  Statins are well known to reduce cholesterol and the atherosclerotic plaques that put people at risk for heart attacks and strokes.  Lower cholesterol levels can reduce overall mortality risk/year by 30%, and so people live longer when they have lower cholesterol levels.  People who live longer extend their opportunity to develop cancer.  And so lower cholesterol levels inadvertently raise your cancer risk simply because they may extend your life.

Why else do I think the link between cancer and statins is faulty?  Because the observed increase in cancer rates was in ALL cancer types – the genetics of cancer is so complex, and the reasons why certain cell types begin to divide in an uncontrolled manner is so diverse, that it’s hard to imagine any possible trigger could stimulate all cells to become cancerous.  Also, most cancers develop very slowly, and the 5 year window in which the authors observed people taking statins and developing cancers is too short to be a cause and effect.  And finally, previous statin safety studies showed no link between them and the development of any form of cancer.

The Journal of the American College of Cardiology admits in an
accompanying editorial, “In the 5 years that we have been stewards of
the Journal, no other manuscript has stimulated such intense scrutiny
or discussion.”  Do I think they should have published this study?  Yes – but to me the most interesting question out of all of this is: could cholesterol screening be used for early cancer detection?  If an extra low LDL is observed, maybe that should prompt some additional investigations to rule out occult malignancies?

Obviously, more studies are needed to determine the potential validity of such an approach… but for now, there is absolutely no reason (based on this study) to cease statin therapy for fear of developing cancer.  Hope that allays some fears!This post originally appeared on Dr. Val’s blog at

You may also like these posts

Read comments »

One Response to “Low Cholesterol And Cancer Risk”

  1. Dr. Scherger says:

    The association of very low cholesterol and cancer has been known for a long time.  When cancer is present, the disease drives the cholesterol down (we lose a lot of body fat too).  So, whenever a study shows this, especially the very small risk here, I suspect there was more early cancer already present than realized to explain the findings.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »