In his article, "Dyslipidemia: Closing the Treatment Gap"(CONSULTANT, April 1, 2003, page 451), Dr David Nashrecommends statin therapy for all eligible elderly patients.
In his article, "Dyslipidemia: Closing the Treatment Gap"(CONSULTANT, April 1, 2003, page 451), Dr David Nashrecommends statin therapy for all eligible elderly patients.However, the Pravastatin in Elderly Individuals at Risk ofVascular Disease (PROSPER) study revealed that a regimenof pravastatin, 80 mg/d, continued for more than 3.2 yearsled to 24 more deaths from cancer than did placebo (eventhough it resulted in 28 fewer deaths from heart attacks).1In light of these results, would Dr Nash advise greater cautionwhen prescribing statins for older patients?-- Richard S. Banfield, MD
New Canaan, Conn
Your concern that treatment with pravastatin resultedin an increase in cancer in the PROSPERstudy calls for clarification and response. The fewcancer deaths seen in that trial occurred early inthe protocol--particularly in the second year--which suggests that the subjects probably entered with anundiagnosed lesion. In addition, a review of the 50,000 patientsin the Scandinavian Simvastatin Survival Study (4S),Cholesterol and Recurrent Events (CARE) study, West ofScotland Coronary Prevention Study (WOSCOPS), HeartProtection Study (HPS), and Long-term InterventionWith Pravastatin in Ischemic Disease (LIPID) study failsto show an increase in cancer risk. Finally, a report of a19,000-patient Dutch study presented at a recent meetingof the American Society of Clinical Oncology indicated thatstatin use lowers cancer risk.1We need not worry about increasing patients' risk ofcancer. In fact, it would be more harmful to withhold appropriatelipid therapy from patients with coronary arteryor peripheral vascular disease.-- David T. Nash, MD
Clinical Professor of Medicine
State University of New York Health Science Center
Shepherd J, Blauw GJ, Murphy MB, et al, for the PROSPER study group.Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomisedcontrolled trial.
American Society of Clinical Oncology. Cholesterol drugs may protect againstcancer: study. Presented at: the American Society of Clinical Oncology Meeting;June 3, 2003; Chicago. Available at: http://www.asco.org. Accessed August 6, 2003.