Do Low Cholesterol Levels Cause Cancer?

We live in a world where a high cholesterol is now considered to be virtually the most terrible and dangerous thing known to man. Everything possible must be done to bring the level down, or else you are going to die of a stroke or heart attack.

The anti-cholesterol propaganda has been so successful that six million people in the UK now take statins each and every day to reduce their risk of heart disease. Something which, I strongly believe, future generations will look back on in amazement. ‘Did they not know that cholesterol is essential for human health….what on earth did they think they were doing?’

Can it really be true that a chemical compound, so important that the liver synthesises at least five times as much as you consume in food, can be disastrous to our health. All cell membranes need it, our brains need it, almost all of our hormones are made out of it, and it is used to make vitamin D in our skin. It has always seemed to me that having too little cholesterol is just as likely to be damaging as having too much – probably more so.

One area I have particular concerns about is cancer. For many years it has been noticed that people with low cholesterol levels are more likely to die of cancer. This has been a consistent finding, for many years, from studies done all around the world1-9.

The statin ‘zealots,’ as I shall call them, are well aware of the association between low cholesterol and cancer, and they have gone out of their way to dismiss the possibility that low cholesterol may cause cancer.

The primary argument they have used is known as reverse causality. This ‘reverse-causality’ hypothesis suggests that depressed LDL-cholesterol levels are the result of subclinical cancer (not the other way round). This idea has been put forward with absolutely no evidence to support it. Despite this, it has been accepted without question.

It is true that if you have advanced cancer, your cholesterol levels fall. This happens for a number of interconnected reasons, including the fact that large tumours use a lot of cholesterol to divide and grow.

However, the idea that a cancer so small, that it cannot not yet be detected, is using up so much cholesterol that it lowers the total cholesterol level throughout the body, is stretching the boundaries of possibility. I would say breaking the bounds of possibility.

The second argument put forward, which is not really an argument, is the ‘how can a low cholesterol level cause cancer anyway.’ It should always be remembered that a great deal of medical research consists of bumping into effects, without understanding how it could happen in the first place – see under penicillin. See more recently under aspirin protecting against cancer. A finding as yet, without any clearly defined mechanism of action.

In short, just because you can’t easily see a mechanism of action, does not mean that it doesn’t exist.  In fact, several possible ways that cholesterol, or to be more accurate lipoproteins, could protect against cancer have been researched in some detail10.

Anyway, as I have always known must happen, the ‘reverse causality’ hypothesis has finally been laid to rest.  A recent analysis of the longest running heart disease research project in the world (the Framingham Study) has shown that low cholesterol levels predate cancer diagnosis by many, many, years. And, to quote:

“Based on these data, it would suggest that lower cholesterol predated the development of cancer by quite a long time. Now, that doesn’t necessarily speak to [low cholesterol] causing the cancer; it could have been related to something else altogether, but it’s not supportive of the hypothesis that cancer caused the low levels of LDL cholesterol. We don’t know why it predates cancer, but it would be premature to attribute it to the cancer itself.” 11

In short, it must now be accepted that cancer doesn’t cause low cholesterol levels. Which leaves the possibility that low cholesterol levels might cause cancer. This, inevitably, leads to the next question. If low levels of cholesterol precede cancer, can statins cause cancer?

The evidence is not conclusive, and I would not claim that it was. But there have been some significant warning signs from statin studies. Just to mention three. In the CARE trial12, twelve women in the statin group had breast cancer at follow up, compared on only one in the placebo group. In the PROSPER study13 there were forty six more cases of cancer in the statin group than the placebo group.

Possibly the most worrying figures come from a Japanese study which looked at nearly fifty thousand people taking statins over six years. They found that the number of cancer deaths was more than three times higher in patients whose total cholesterol was less than 4.0mmol/l at follow-up, compared with those whose cholesterol was normal or high:

The patients with an exceptionally low TC (total cholesterol) concentration, the so-called ‘hyper-responders’ to simvastatin, had a higher relative risk of death from malignancy than in the other patient groups.’

The authors then went on to warn:

Malignancy was the most prevalent cause of death. The health of patients should be monitored closely when there is a remarkable decrease in TC (cholesterol) and LDL-C (Low Density Lipoprotein ‘bad cholesterol’) concentrations with low-dose statin.’14
This is not proof of causation, but these are warning signs. Armed with the Framingham data, I believe that the medical profession has to face up to the painful reality that low cholesterol levels could be a cause of cancer, and this needs to be properly researched. We must remember that it took Richard Peto more than thirty years to prove that smoking caused lung cancer, and no statin trial has lasted longer than six.

1. Williams RR, Sorlie PD, Feinleib M, McNamara PM, Kannel WB, Dawber TR. Cancer incidence by levels of cholesterol. JAMA 1981; 245:247–52.

2. Salmond CE, Beaglehole R, Prior IA. Are low cholesterol lvalues associated with excess mortality? BMJ 1985;290:422–4.

3. Schatzkin A, Hoover RN, Taylor PR, Ziegler RG, Carter CL,Larson DB, et al. Serum cholesterol and cancer inthe NHANES I epidemiologic followup study. NationalHealth and Nutrition Examination Survey. Lancet 1987;2:298–301.

4. To¨rnberg SA, Holm LE, Carstensen JM, Eklund GA. Cancer

incidence and cancer mortality in relation to serum cholesterol. J Natl Cancer Inst 1989; 81:1917–21.

5. Isles CG, Hole DJ, Gillis CR, Hawthorne VM, Lever AF.Plasma cholesterol, coronary heart disease, and cancer inthe Renfrew and Paisley survey. BMJ 1989; 298:920–4.

6. Kreger BE, Anderson KM, Schatzkin A, Splansky GL. Serum cholesterol level, body mass index, and the risk of coloncancer. The Framingham Study. Cancer 1992; 70:1038–43.

7. Schuit AJ, Van Dijk CE, Dekker JM, Schouten EG, Kok FJ.Inverse association between serum total cholesterol andcancer mortality in Dutch civil servants. Am J Epidemiol1993; 137:966–76.

8. Chang AK, Barrett-Connor E, Edelstein S. Low plasma cholesterol predicts an increased risk of lung cancer in elderlywomen. Prev Med 1995; 24:557–62.

9. Steenland K, Nowlin S, Palu S. Cancer incidencein the National Health and Nutrition Survey I. Follow-updata: diabetes, cholesterol, pulse and physical activity.Cancer Epidemiol Biomarkers Prev 1995; 4:807–11

10: http://qjmed.oxfordjournals.org/content/early/2011/12/08/qjmed.hcr243.full.pdf?keytype=ref&ijkey=kZGZxqVjYWEOtoc

11: http://www.theheart.org/article/1375049.do?utm_campaign=newsletter&utm_medium=email&utm_source=20120325_ACC_dimanche_2

12: Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD,Cole TG, et al. Effect of pravastatin on cardiovascular eventsin women after myocardial infarction: the cholesterol and recurrent events (CARE) trial. N Engl J Med 1996;335:1001–9

13: Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM,Cobbe SM, et al. Pravastatin in elderly individuals at risk ofvascular disease (PROSPER): a randomised controlled trial.Lancet 2002; 360:1623–30.

14: . Matsuzaki M, Kita T, Mabuchi H, Matsuzawa Y, Nakaya N,Oikawa S, et al. Japan Lipid Intervention Trial. Large scalecohort study of the relationship between serum cholesterol lconcentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia. Circ J 2002; 66:1087–95.

 

11 thoughts on “Do Low Cholesterol Levels Cause Cancer?

  1. tedhutchinson

    I came across this paper recently Association between serum cholesterol and noncardiovascular mortality in older age” They say each 1-mmol/L increase in total cholesterol was associated with an approximately 12% lower risk of noncardiovascular mortality …. this was driven largely by non-high-density lipoprotein cholesterol (non-HDL-C) and was partly attributable to cancer mortality” Interesting to speculate on why older people with higher levels of cholesterol were less likely to die from cancer?

    Reply
  2. Chris.

    A few months ago, I experienced blurred vision in my right eye, which the hospital doctors put down to a TIA, although at first they said it was diseased, but changed their opinion after blood test results. They then said my cholesterol was high at 6.4 and I was prescribed Simvostatin 40mg; i was told I would have to take this for the rest of my life.

    I read up about statins on the internet, and decided not to take them, as the side effects looked horrible. Instead I’ve been eating more healthy and doing more exercise.

    I have however, been taking these natural herbal pills I purchased on the internet, called Cholest-Natural made by xtendlife, which supposedly lower cholesterol levels, I have run out now and was going to order more, but having just read your book, I was wondering if there is any point, since they are expensive.

    Would you recommend taking simvostatin 40mg or natural herbal cholesterol lowering dietary supplements daily following a suspected TIA? I am 39 years old.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Chris,

      As you might expect, I cannot really give specific medical advice in this forum, as I am bound by GMC regulations.
      A couple of points, though. Most importantly, there is not really any such thing as a TIA. Although I do not know your history, a TIA is a small stroke. It should be treated as seriously as a full blown stroke, and you need to know what caused it. Small strokes can be due to atrial fibrillation – disorganised heart beat. This can be treated. If the AF cannot be treated, you may have to think about anti-coagulant treatment e.g. warfarin. It may not have been a small stroke, but something else. Multiple Sclerosis, for example, can create symptoms that mimic stroke. As can forms of epilepsy, or migraine etc etc. Personally, if I had a small stroke then I would damned well want to know why – or if I had really had one? Have you had a brain scan CT, or MRI, for example. Have you had clotting factor analysis etc. etc. Before taking preventative treatment of any kind, you really need to know what you are treating.

      I hope this is helpful.

      Reply
  3. Chris.

    That you for your reply.

    They gave me an ECG, and said that was find.A carotid scan showed less than 20% stenosis bilaterally, whatever that means?

    I have not had a brain scan CT, or MRJ and I don’t know what a clotting factor analysis is. The only treatment I have has is told to take low level aspirin everyday, which I am taking, and Simovostatin 40mg every night, which I’m not taking. They want me to have some blood tests to repeat my viscosity and a repeat cholesterol with HDL and LDL breakdown; I put them off but they keep hassling me to have them, so I’m booked in a couple of weeks. I’ve not told them yet I’ve been a naughty boy and not taking my statins.

    Reply
  4. Vineet

    I and 45 and as per a recent blood test, I have low cholestrol (130). Need I worry? I have not been taking statins or anything. I don’t smoke or drink and am on a largely vegetarian diet with occasional chicken. In fact, i have a nice helping of home made butter alongwith my breakfast, although the content of oil for cooking is low in our house, and we’re largely off any fast food (only an occassional pizza or burger once a month maybe)

    Reply
  5. virtualciti

    I and 45 and as per a recent blood test, I have low cholestrol (130). Need I worry? I have not been taking statins or anything. I don’t smoke or drink and am on a largely vegetarian diet with occasional chicken. In fact, i have a nice helping of home made butter alongwith my breakfast, although the content of oil for cooking is low in our house, and we’re largely off any fast food (only an occasional pizza or burger once a month maybe)

    Reply
    1. Dr. Malcolm Kendrick Post author

      I don’t think I would worry. When we are talking increased risks, the risk are – in absolute terms – very small. Your cholesterol is mainly genetically determined. If there is any cancer history in your family, it may be worth looking into it. General advice: exercise, don’t smoke, eat what you like.

      Reply
      1. vineet

        Thanks, that’s very relaxing for my father who’s very anxious about numbers. Well really no known case of cancer in family. and are there general checkups for cancer that may be done?

  6. virtualciti

    one small thing: i read at many places that use of statins (for checking cholesterol levels) may cause or may indicate oncoming cancer. So when i don’t use statins and didn’t personally lower my cholesterol is it still an issue?

    Reply
  7. dennis laviolette

    what about using Amgen’s REPATHA which only targets LDL’s ? I’m in a clinical trial in Victoria

    is a low ldl prone to cancer?

    Reply
  8. Kevin O'Connell

    Thanks to Igor’s excellent index of your posts, I have just seen this.

    I have for some years suspected that rosuvastatin may have been causal and was at least faciltative of my cancer (PCa).

    In late 2006 my doctor explained that I ‘qualified’ for a statin (‘best thing since sliced bread’ adding ‘years’ to the life of middle and older aged men).

    My TC was 6.4 (265) and LDL 4.22 (163).
    I was prescribed low dose rosuvastatin (Crestor 5mg). A few months later:
    TC 4.08 (158) and LDL 1.89 (73).
    Thus I was surely a ‘hyper-responder’.
    At the beginning of 2009 I was diagnosed with PCa (Gleeson 3+4). At that time TC was 4.36 (169) & LDL 1.76 (68). Surgery, then radiation followed. After a brief dip, PSA continued a steady rise.
    In October 2011 I switched to a LCHF diet (reduction in glucose & fructose probably helpful for controlling the cancer and rapid weight loss of 2-3kg a month did not do any harm!) and shortly after stopped the statin.
    A month or so later my TC was 5.19 (201), LDL 3.18 (123) and my PSA dropped and stabilized, remaining dead flat for 3 years+.

    n=1, possible coincidence(s), blah, blah, but I think it was probably causal (in both directions). Certainly seems to fit in with Matzusaki et al.

    Reply

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