If you believe the drug manufacturers, you might
think that statins are the best thing since sliced bread. Recent studies
suggest that not only do they lower cholesterol, prevent heart disease
and reduce the risk for heart attack and stroke, they also may cut
Alzheimer's risk... help prevent glaucoma... ease macular degeneration...
and reduce the inflammation and scarring of the Myelin sheath (a fatty
covering that protects nerve fibers) and underlying nerve that cause
multiple sclerosis. The response overall has been so positive that an
over-the-counter version of one statin has been made available in the UK.
(See Daily Health News, October 7, 2004.)
Now a new study reports that people who take statins
experience another unexpected benefit -- a reduced risk of developing
colorectal cancer. Other research suggests that statins offer protection
against prostate and kidney cancer, breast cancer and melanoma.
Should we all start popping statins?
DON'T LEAP TO CONCLUSIONS
The answer to that question is an emphatic no,
according to Jay S. Cohen, MD, associate professor (voluntary) of family
and preventive medicine at University of California, San Diego, and author
of What You Must Know About Statin Drugs and Their Natural Alternatives
(Square One). He told me that the side effects of statins are drastically
underestimated by pharmaceutical companies.
Even researchers who conducted the latest cancer study
caution that it is too soon to leap to that conclusion, noting that findings
are preliminary and that statins have potentially serious side effects. Not
only that, there are far less risky ways to prevent colorectal cancer,
including healthy diet, regular exercise and screening tests
for early detection.
ABOUT THE RESEARCH
The study was observational and based on questionnaires
rather than strict scientific controls. It involved nearly 4,000 Israelis
with an average age of 70. Approximately half had colorectal cancer, and
the other half were disease free. Researchers found that those who used
statins for five or more years experienced a 51% reduction in the risk
for colorectal cancer. Even when other risk-lowering factors were taken
into account (aspirin use, diet, exercise, cancer-screening practices
and family history), use of statins for at least five years was associated
with a 46% reduction in risk.
Most of the people in the study took pravastatin
(Pravachol) or simvastatin (Zocor), the most commonly used statins
in Israel. However, researchers believe that all statins probably
have the same protective effect.
Statins may reduce colorectal cancer risk by
interfering with the action of cancer-related genes. Other cholesterol-
lowering drugs (such as fibrates) do not appear to offer
similar protection.
Because this study was observational, based
on questionnaires rather than on strict scientific controls,
further research is needed. The results were announced at the annual
meeting of American Society for Clinical Oncology.
TAKING A SECOND LOOK
Dr. Cohen is concerned that in the rush of enthusiasm
for all things statin, we fail to fully take into account the impact of
their side effects. While drug companies report that these affect only 1%
to 2% of statin users, Dr. Cohen says that published data show that some
15% to 30% of people who take these drugs experience muscle pain, joint pain,
abdominal discomfort or cognitive or memory problems.
About 60% of people who are prescribed statins quit taking
them, notes Dr. Cohen, often because of intolerable side effects. In other
cases, even though the effects can be severe, statin users fail to make the
connection and do not attribute them to statin use. Unfortunately, doctors
often make the same mistake. There are reports of people with statin-related
confusion, altered mood, impaired memory or debilitating muscle pain, whose
complaints are dismissed by their physicians because they fail to associate
them with statins. Or worse, additional drugs are prescribed to control
these symptoms, leading to even more side effects.
Dr. Cohen says that we also need to take a second
look at why statins have become so popular. More and more scientists
believe that inflammation is the key to understanding and controlling
not only heart disease but all major age-related diseases as well.
Statins have a positive impact on these diseases because they reduce
inflammation. But, Dr. Cohen asks, why isn't anybody asking why we are
so inflammation-prone in the first place?
He believes that drug companies should invest more
of their research dollars into learning the answer to that question
rather than spending hundreds of millions of dollars finding new ways
to market best-selling drugs. For example, Dr. Cohen points out that
Americans consume far too many omega-6 fatty acids and not enough
omega-3s, which creates an inflammatory climate in our bodies --
yet this is not a profitable avenue of research for drug companies,
and so it is neglected.
HOW TO PREVENT COLORECTAL CANCER
According to the American Cancer Society
(ACS), doctors must be certain that cancer protection outweighs
the risk for possible side effects before prescribing statins to
people for any reason other than lowering cholesterol.
The ACS notes that regular screening tests are
a better option for preventing colorectal cancer, which is in fact
one of the most preventable cancers. With regular screening after
age 50, noncancerous tumors, called polyps, can be found and removed
early to stop cancer from starting.
Beginning at age 50, both men and women at average
risk of developing colorectal cancer should follow one of these five
testing schedules...
Yearly fecal occult blood test (FOBT) (the take-home
multiple sample method should be used) or fecal immunochemical
test (FIT).
Flexible sigmoidoscopy every five years.
Yearly FOBT or FIT plus flexible sigmoidoscopy
every five years (this combination is preferred over either of these
options alone).
Double-contrast barium enema every five years.
Colonoscopy every 10 years.
All positive tests should be followed up with colonoscopy.
People should begin colorectal screening earlier and/or
undergo screening more often if they have any of the following colorectal
cancer risk factors...
A personal history of colorectal cancer or adenomatous polyps.
A strong family history of colorectal cancer or polyps
(cancer or polyps in a first-degree relative younger than 60 years old or
in two first-degree relatives of any age). Note: A first-degree relative
is defined as a parent, sibling or child.
A family history of an hereditary colorectal cancer syndrome
(familial adenomatous polyposis or hereditary non-polyposis colon cancer).
In addition to screening, the Harvard Center for Cancer
Prevention recommends lifestyle changes...
Get at least 30 minutes of physical activity every day.
Maintain a healthy weight.
Eat no more than two to three servings of red meat a week.
Take a multivitamin with folate every day.
Drink less than one alcoholic drink a day.
Eat five or more servings of fruits and vegetables every day.
Don't smoke.
Once again, the answer is not a magic pill. A healthy
lifestyle is your best and safest bet to prevent cancer and other diseases
that grow more common as we age.
Sources...
Jay S. Cohen, MD, associate professor (voluntary)
of family and preventive medicine at the University of California,
San Diego. Dr. Cohen is author of What You Must Know About Statin Drugs
and Their Natural Alternatives (Square One) and Over Dose: The Case
Against The Drug Companies (Tarcher/Putnam). Visit his Web site at
www.medicationsense.com
American Cancer Society. www.cancer.org
Harvard Center for Cancer Prevention, Harvard School of
Public Health. www.hsph.harvard.edu/cancer
