Statins Significantly Increase Cancer Risk In The Elderly

| May 2, 2011

As a population we’re living longer. Generally speaking, older individuals are more prone to chronic conditions such as heart disease and cancer. With statin drugs continuing to be a mainstream mainstay in the prevention of heart disease, the elderly represent a growing market for these drugs.

While this may be lucrative for pharmaceutical companies, are there any real benefits to be had from prescribing statins to elderly individuals?

One of the most significant trials of statin therapy in the elderly is known as the PROSPER study [1]. In this study, almost 6,000 men and women aged 70-82 were treated with a statin (pravastatin) or placebo for over three years. Each of the individuals in this trial had either a history of cardiovascular disease (e.g. a previous heart attack) or significant risk factors for cardiovascular disease. In this sense, the individuals were deemed to be at relatively high risk of cardiovascular events such as heart attack or stroke. This is relevant as relatively high-risk individuals stand to gain more from statin therapy compared to low-risk individuals.

Risk reduction of non-fatal and fatal heart attacks (added together) was 19 per cent in the group taking the statin. Stroke incidence was not affected. Cancer rates were 25 per cent higher in the group taking pravastatin. Overall, risk of death was the same between the groups.

Despite these really very unimpressive results, the authors concluded that PROSPER provides evidence that the cholesterol treatment strategies applied to middle-aged people should be extended to the elderly. What the study actually showed was that treatment with pravastatin in the elderly has no overall benefit, causing me to question the authors’ enthusiasm for this practice.

A similar view was expressed in an opinion piece that featured in the British Medical Journal some years after the publication of the PROSPER study [2]. In this piece, three doctors (one based in New Zealand and two others from the UK) questioned the use of statin drugs in the elderly. The doctors cite the PROSPER study and suggest that the taking of statins by the elderly is likely to give with one hand and take with the other: cardiovascular risk goes down while risk of cancer goes up.

The authors stated: “By providing treatments designed to prevent particular diseases, we may be selecting for another cause of death unknowingly, and certainly without the patient’s informed consent. This is fundamentally unethical and undermines the principle of respect for autonomy.” They went on to add that: “Prevention has side effects other than the hazards of the treatment – in particular, the shadow cast over a currently healthy life by the threat of disease, which might be magnified in elderly people for whom mortality looms closer.”

One reason for why statin treatment is so entrenched in mainstream medical care in the UK relates to the fact that general practitioners are remunerated by the Government for this practice. As the authors point out, offering doctors financial incentives may coerce doctors into persuading patients to accept such preventive treatments. There is evidence that this sort of remuneration actually changes health care practice [3]. As the authors of this paper state, whether this improves actual health care is not always so clear.

Here’s to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


References:

1. Shepherd J, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360(9346):1623-30

2. Mangin D, et al. Preventive health care in elderly people needs rethinking BMJ 2007;335:285-287

3. Petersen LA, et al. Does pay-for-performance improve the quality of health care? Ann Intern Med 2006;145:265-72

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Category: Statin Drugs Side Effects

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