Statins and Malignancies in Cardiovascular Practice

Abstract

Statins have a proven efficacy in lowering of plasma cholesterol and reduction of atherosclerotic cardiovascular disease. They also have anti-inflammatory, pro-apoptotic and anti-angiogenic effects which can be derived from their biochemical activity. The cell cycle could also be arrested at several stages. However, an early concern was the possibility of increase in malignancy. The first reports were conflicting.

A search in Web of Science has been made with the terms “statins AND malignancyâ€, from 2012 to 2017.

Twenty of 119 manuscripts were considered as useful. Manuscripts dealing with in-vitro and animal experiments were excluded, as well as reviews and manuscripts not related to the topic. There was a variety of malignancies under scrutiny. Most series showed a favorable result on either reduction of incidence in malignancy or, if a malignancy was diagnosed and improvement in overall or cancer specific survival. Reduction in symptoms and improvement in inflammatory response after adjuvant chemo and radiotherapy were documented in a few reports.

Elimination of bias has been attempted by taking into account confounding factors or by using a propensity analysis or a multivariate regression. Interpreting these results is difficult due to the differences in study designs. This precluded a meta-analysis. The disentangling of the effect of statins on malignancy, plasma cholesterol and changes of this level in these patients requires a large multicenter prospective trial which might encounter ethical and logistical difficulties.