A statin a day??

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I remember when the statins first came out in the late 1980’s. I had a mildly elevated cholesterol that didn’t respond much to the dietary changes (admittedly few) I was willing to make, so taking a statin seemed like a great step forward. But… were they safe? Of course the same could be asked of aspirin, bike riding, eating meat, or skiing. It’s really about risk/benefit in the end. In the years that followed, I ended up taking statins with the permission of my doctor and they work far better than dietary manipulation for my cholesterol and I combine their use with exercise for all of the other benefits (read here). I previously posted about statin use here, but there are new data all the time worth keeping up with.

In a recent JCO article, a large group (31,790) of Danish men were evaluated for prostate cancer specific and overall mortality depending on their use of statins. Even though there was a higher mortality from prostate cancer than is usually seen in such studies (23% – potentially because there is lower use of screening in Denmark), the prostate cancer specific death rate and overall death rate was 15-20% lower in the men who took statins after diagnosis. This was regardless of their treatment (surgery, radiation, hormones). Since I mentioned aspirin, other studies have suggested that men with high Gleason scores (≥8) may benefit from aspirin use as well. Statins have also been shown to inhibit a long list of other cancer causes of death that you can read about in Wikipedia, so the benefits to prostate cancer patients, who often die of other cancers or cardiovascular disease is not limited to their concerns about prostate cancer itself.

In an editorial accompanying the JCO article by Mucci and Kantoff, there is a thoughtful review of whether statins should be recommended for all men with prostate cancer. The article also discusses how they might work to slow down prostate cancer, so be sure to read it for the excellent summary. They conclude that the evidence is still not there, although certainly the large number of studies and meta-analyses they provide make a strong case. My question would be “what is the risk?”, and it seems to be minimal. Statins are cheap and widely available. They provide risk-lowering effects on cholesterol/heart disease, and the only side effect that is a problem in general is the muscle pain that occurs in some patients, which almost always goes away when you stop the drug. I can’t disagree with the thought that a prospective randomized trial in a subgroup of prostate cancer patients is desirable, but in the absence of such a trial to invite patients’ participation, I personally encourage patients to take statins unless their primary care physician disagrees. For that matter, I would almost encourage their presence in the water supply like fluorides given all their other benefits (just kidding, but they really do have a long list of benefits and very favorable risk profile in my view).

An apple a day is a good idea. Statins should maybe join that, and keep exercising!