Cholesterol and cancer: do cholesterol-lowering drugs lead to tumors? - includes related article on American College of Physician's cholesterol screening proposal

Science News, March 2, 1996 by Kathleen Fackelmann

Cancer isn't the only problem with gemfibrozil. The fine print in the 1994 PDR indicates that middle-aged men with heart disease who took the drug actually increased their risk of dying, both from another heart attack and from all causes.

That evidence, along with the potential threat of cancer, has spurred Public Citizen to call for a ban on gemfibrozil. The group's book, Worst Pills, Best Pills II (1993), advises consumers not to use Lopid. "There is no proof that gemfibrozil has any hea lth benefit," the book says. Instead, authors Sidney M.

Wolfe and Rose-Ellen Hope suggest alternative ways to lower cholesterol concentrations in the blood, such as exercise and a diet low in saturated fat.

In contrast to the fibric acid durgs, the statin drugs have seen their reputation enhanced in recent months. In the Nov. 16, 1995 New England Journal of Medicine, James Shepherd at the University of Glasgow and his colleagues report that pravastatin (Prav achol) reduced the risks of experiencing and dying from a heart attack in middle-aged men with high cholesterol concentrations. The results of this trial suggest that there are "massive benefits" to the use of a cholesterol-lowering drug like the statins, Cleeman says.

Newman and Hulley concede that the statins offer advantages to a narrow group of people at high risk of heart disease. For middle-aged men who cannot lower their cholesterol with diet or exercise, such drugs may be lifesavers, they say.

However, they are concerned about the cancer-causing potential of the drugs for most people in their twenties and thirties. Cancers take many years to develop; a person popping such pills every day for decades might run a cancer risk, they worry.

Moreover, cholesterol-lowering drugs have never been proved to benefit the very old, the very young, or women, they say.

Cleeman counters that women and the elderly are not different from middle-aged men when it comes to heart disease. "Based on what we know from trials to date . . . the prudent approach is to treat women and the elderly in the same fashion," he says. If a low-fat diet fails, they should then consider medication to lower their cholesterol, he adds.

Although most experts advise against the use of cholesterol-lowering drugs in children and young adults, there's one exception: those with a genetic predisposition to sky-high cholesterol. Without drug treatment, such young people face an extremely high r isk of heart attack, Cleeman notes.

The federal government's drive to screen people age 20 and older for high cholesterol (see sidebar) may fuel the sales of cholesterol-lowering pills, Newman and Hulley argue. They say such programs turn healthy people into patients and spur the inappropri ate use of drugs. Many people have no symptoms of heart disease but have a cholesterol reading that puts them in a "risk" category. Newman and Hulley are concerned that for millions of people, the potential cancer risk of the medication overshadows any he art benefits.

Cleeman counters by saying that asymptomatic people with high cholesterol concentrations are indeed at risk.