Should I take statins? Statins can reduce your risk of heart disease and cancer
Many people don’t like taking statins because of side effects, yet they can be vital to reducing your risk of heart-related problems and death. Another benefit is a lower risk of cancer. A recent analysis of large-scale health data identified a significantly lower incidence of cancers in people taking cholesterol-lowering medications called statins. Statins work by blocking the HMG-CoA reductase enzyme essential for cholesterol synthesis. Statins are recommended for people with congestive heart disease, diabetes, and other conditions to decrease the risk of heart attacks. Understanding your genetic profile can help optimize statin selection and dosage to minimize side effects.
Common statins include:
- atorvastatin (Lipitor)
- fluvastatin (Lescol XL)
- lovastatin (Altoprev)
- pitavastatin (Livalo)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor)
In addition to statins, other treatments can lower cholesterol levels, including fibrates (fenofibrate, gemfibrozil), niacin, and ezetimibe (Zetia) that reduce cholesterol absorption. The newest cholesterol-lowering drug class is PCSK9 inhibitors, including alirocumab (Praluent) and evolocumab (Repatha), which block cholesterol synthesis. PSCK9 inhibitors have the most significant reduction in cholesterol levels and are used for people with Familial Hyperlipidemia or statin-intolerant patients.
Cholesterol and diet
It is known that the consumption of fatty foods, including red meat, has been associated with an increased risk of cancer. The general advice to reduce consumption of processed foods high in saturated and trans fats is vital for your health. Statins are necessary for people that still have elevated cholesterol levels even with a healthy diet. Yet, many people are reluctant to take statins or stop taking these medications because of common side effects such as muscle and joint pain.
Cholesterol levels and cancer risk – correlation or causation?
New clinical studies demonstrate that cholesterol-lowering drugs lower the risk of heart disease and cancer, and increase overall longevity.
Statistical analyses showed that statin medications reduce the risk of heart disease and cancer. Still, it was unclear if improved survival is directly linked to cholesterol levels or other drug-induced mechanisms. The ultimate proof came from a genetic analysis of 360,000 individuals that compared the incidence of cancers among people with inherently lower cholesterol levels. The findings showed that mutations in several genes could result in lower cholesterol synthesis:
- The HMGCR gene produces the HMG-CoA enzyme, which is the target of statins. This enzyme had a strong protective effect on heart and cancer mortality risk. However, mutations in other genes that lower cholesterol, namely the PCSK9, LDLR, NPC1L1, APOC3, LPL, did not lower cancer risk.
- This finding demonstrates that, like statins, HMGCR mutations reduce cancer risk independent of cholesterol levels. Although it is still not clear exactly how statins reduce cancer risk, it is thought that statins have an anti-inflammatory effect.
How to balance the risk of statin-induced side effects vs long-term benefits?
Statins lower the risk of heart disease and cancer but also may increase the risk of type 2 diabetes and intracerebral hemorrhage. Statins are also known to induce muscle pains, the most common reason for treatment discontinuation.
The genetics of statin metabolism
Variations in genes SLCO1B1 and ABCG2 affect the transport and drug accumulation of statins in the body for people with reduced function of these genes. Another gene, CYP2C9, also impacts the metabolism of fluvastatin in particular. Therefore, knowing your genetic profile can help you choose a better statin and the optimal dose that will enable you to continue treatment while minimizing the risk of side effects.
Pharmacogenetic testing to optimize medications
The Pillcheck pharmacogenetic test lets you know the status of your SLCO1B1, ABCG2, and CYP2C9 enzymes and your predicted response to statins and many other medications. The service also includes a comprehensive medication review by an expert pharmacist to resolve drug-gene-drug interactions. The Pharmacist summarizes the findings and recommendations to help your doctor prescribe the optimal statin and dose so you can continue therapy, reducing your risk of heart disease and cancer.
- Statins are essential for reducing the risk of heart attack and strokes. They also lower cancer risk. In addition, continuous statin therapy can extend the life span.
- Although other cholesterol-lowering medications tend to have fewer side effects, these drugs do not reduce cancer incidence.
- Pharmacogenetics-based statin prescribing can reduce your risk of side effects. Pharmacogenetic testing combined with a medication review could help you continue statin therapy even if you experienced drug-induced side effects in the past.
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Carter P, Vithayathil M, Kar S, Potluri R, Mason AM, Larsson SC, Burgess S Predicting the effect of statins on cancer risk using genetic variants from a Mendelian randomization study in the UK Biobank. Elife. 2020 Oct 13;9:e57191.
Longo J et al., Statins as Anticancer Agents in the Era of Precision Medicine Clin Cancer Res. 2020 Nov 15;26(22):5791-5800.
Cooper-DeHoff R et al., The Clinical Pharmacogenetics Implementation Consortium
(CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms (2022), in press