Statins: Possible noncardiovascular benefits
- Robert S Rosenson, MD
Robert S Rosenson, MD
- Section Editor — Lipids
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
Lipid lowering, at least with statins, is beneficial in patients with dyslipidemias for both primary and secondary prevention of coronary heart disease. (See "Clinical trials of cholesterol lowering for primary prevention of coronary heart disease" and "Clinical trials of cholesterol lowering in patients with cardiovascular disease or diabetes".)
In addition to cholesterol lowering and the primary and secondary prevention of cardiovascular disease, statin therapy may be associated with other benefits. Most of these other benefits have been found as associations in observational studies, rather than in randomized trials. As such, there is potential confounding and bias in that patients receiving better medical care, and those more adherent to medical therapy, may be more likely to be taking statins and also be at lower risk for certain noncardiovascular diseases.
Potential noncardiovascular benefits of statins are discussed here. Side effects and toxicities of statins are discussed separately. (See "Statins: Actions, side effects, and administration".)
Some observational studies have suggested that statins may decrease the risk of dementia and at least one small randomized trial has suggested that statins may slow the progression of dementia. (See "Prevention of dementia", section on 'Statins' and "Treatment of dementia", section on 'Risk factor control'.)
- Friis S, Poulsen AH, Johnsen SP, et al. Cancer risk among statin users: a population-based cohort study. Int J Cancer 2005; 114:643.
- Graaf MR, Beiderbeck AB, Egberts AC, et al. The risk of cancer in users of statins. J Clin Oncol 2004; 22:2388.
- Karp I, Behlouli H, Lelorier J, Pilote L. Statins and cancer risk. Am J Med 2008; 121:302.
- Poynter JN, Gruber SB, Higgins PD, et al. Statins and the risk of colorectal cancer. N Engl J Med 2005; 352:2184.
- Kaye JA, Jick H. Statin use and cancer risk in the General Practice Research Database. Br J Cancer 2004; 90:635.
- Khurana V, Singh T, Chalasani R, et al. Statins do not reduce colon cancer risk in humans: a case control study. Gastroenterology 2004; 126 (Suppl):A452.
- Jacobs EJ, Rodriguez C, Brady KA, et al. Cholesterol-lowering drugs and colorectal cancer incidence in a large United States cohort. J Natl Cancer Inst 2006; 98:69.
- Coogan PF, Smith J, Rosenberg L. Statin use and risk of colorectal cancer. J Natl Cancer Inst 2007; 99:32.
- Eliassen AH, Colditz GA, Rosner B, et al. Serum lipids, lipid-lowering drugs, and the risk of breast cancer. Arch Intern Med 2005; 165:2264.
- Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376:1670.
- Dale KM, Coleman CI, Henyan NN, et al. Statins and cancer risk: a meta-analysis. JAMA 2006; 295:74.
- Browning DR, Martin RM. Statins and risk of cancer: a systematic review and metaanalysis. Int J Cancer 2007; 120:833.
- Cholesterol Treatment Trialists' (CTT) Collaboration, Emberson JR, Kearney PM, et al. Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy. PLoS One 2012; 7:e29849.
- Khurana V, Bejjanki HR, Caldito G, Owens MW. Statins reduce the risk of lung cancer in humans: a large case-control study of US veterans. Chest 2007; 131:1282.
- Nielsen SF, Nordestgaard BG, Bojesen SE. Statin use and reduced cancer-related mortality. N Engl J Med 2012; 367:1792.
- Yu O, Eberg M, Benayoun S, et al. Use of statins and the risk of death in patients with prostate cancer. J Clin Oncol 2014; 32:5.
- Caporaso NE. Statins and cancer-related mortality--let's work together. N Engl J Med 2012; 367:1848.
- Tonelli M, Moyé L, Sacks FM, et al. Effect of pravastatin on loss of renal function in people with moderate chronic renal insufficiency and cardiovascular disease. J Am Soc Nephrol 2003; 14:1605.
- Vidt DG, Cressman MD, Harris S, et al. Rosuvastatin-induced arrest in progression of renal disease. Cardiology 2004; 102:52.
- Ando H, Takamura T, Ota T, et al. Cerivastatin improves survival of mice with lipopolysaccharide-induced sepsis. J Pharmacol Exp Ther 2000; 294:1043.
- Merx MW, Liehn EA, Janssens U, et al. HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis. Circulation 2004; 109:2560.
- Giusti-Paiva A, Martinez MR, Felix JV, et al. Simvastatin decreases nitric oxide overproduction and reverts the impaired vascular responsiveness induced by endotoxic shock in rats. Shock 2004; 21:271.
- Terblanche M, Almog Y, Rosenson RS, et al. Statins: panacea for sepsis? Lancet Infect Dis 2006; 6:242.
- Terblanche M, Almog Y, Rosenson RS, et al. Statins and sepsis: multiple modifications at multiple levels. Lancet Infect Dis 2007; 7:358.
- Stefanec T. The effects of statins on mortality rates among bacteremic patients. Clin Infect Dis 2002; 34:1158.
- Almog Y, Shefer A, Novack V, et al. Prior statin therapy is associated with a decreased rate of severe sepsis. Circulation 2004; 110:880.
- Thomsen RW, Hundborg HH, Johnsen SP, et al. Statin use and mortality within 180 days after bacteremia: a population-based cohort study. Crit Care Med 2006; 34:1080.
- Hackam DG, Mamdani M, Li P, Redelmeier DA. Statins and sepsis in patients with cardiovascular disease: a population-based cohort analysis. Lancet 2006; 367:413.
- Gupta R, Plantinga LC, Fink NE, et al. Statin use and sepsis events [corrected] in patients with chronic kidney disease. JAMA 2007; 297:1455.
- Majumdar SR, McAlister FA, Eurich DT, et al. Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study. BMJ 2006; 333:999.
- Thomsen RW, Riis A, Kornum JB, et al. Preadmission use of statins and outcomes after hospitalization with pneumonia: population-based cohort study of 29,900 patients. Arch Intern Med 2008; 168:2081.
- Chalmers JD, Singanayagam A, Murray MP, Hill AT. Prior statin use is associated with improved outcomes in community-acquired pneumonia. Am J Med 2008; 121:1002.
- Douglas I, Evans S, Smeeth L. Effect of statin treatment on short term mortality after pneumonia episode: cohort study. BMJ 2011; 342:d1642.
- Yende S, Milbrandt EB, Kellum JA, et al. Understanding the potential role of statins in pneumonia and sepsis. Crit Care Med 2011; 39:1871.
- Tleyjeh IM, Kashour T, Hakim FA, et al. Statins for the prevention and treatment of infections: a systematic review and meta-analysis. Arch Intern Med 2009; 169:1658.
- Chopra V, Rogers MA, Buist M, et al. Is statin use associated with reduced mortality after pneumonia? A systematic review and meta-analysis. Am J Med 2012; 125:1111.
- van den Hoek HL, Bos WJ, de Boer A, van de Garde EM. Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials. BMJ 2011; 343:d7281.
- Novack V, MacFadyen J, Malhotra A, et al. The effect of rosuvastatin on incident pneumonia: results from the JUPITER trial. CMAJ 2012; 184:E367.
- Tonolo G, Melis MG, Formato M, et al. Additive effects of Simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients. Eur J Clin Invest 2000; 30:980.
- Spósito AC, Mansur AP, Coelho OR, et al. Additional reduction in blood pressure after cholesterol-lowering treatment by statins (lovastatin or pravastatin) in hypercholesterolemic patients using angiotensin-converting enzyme inhibitors (enalapril or lisinopril). Am J Cardiol 1999; 83:1497.
- Preiss D, Tikkanen MJ, Welsh P, et al. Lipid-modifying therapies and risk of pancreatitis: a meta-analysis. JAMA 2012; 308:804.
- Gokce Mİ, Gülpınar Ö, Öztürk E, et al. Effect of atorvastatin on erectile functions in comparison with regular tadalafil use. A prospective single-blind study. Int Urol Nephrol 2012; 44:683.
- La Vignera S, Condorelli RA, Vicari E, Calogero AE. Statins and erectile dysfunction: a critical summary of current evidence. J Androl 2012; 33:552.
- Park K, Cho SY, Kim SW. Erectile response to type 5 phosphodiesterase inhibitor could be preserved with the addition of simvastatin to conventional insulin treatment in rat model of diabetes. Int J Androl 2011; 34:e468.
- Trivedi D, Kirby M, Wellsted DM, et al. Can simvastatin improve erectile function and health-related quality of life in men aged ≥40 years with erectile dysfunction? Results of the Erectile Dysfunction and Statins Trial [ISRCTN66772971]. BJU Int 2013; 111:324.
- El-Sisi AA, Hegazy SK, Salem KA, AbdElkawy KS. Atorvastatin improves erectile dysfunction in patients initially irresponsive to Sildenafil by the activation of endothelial nitric oxide synthase. Int J Impot Res 2013; 25:143.
- Dadkhah F, Safarinejad MR, Asgari MA, et al. Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil. Int J Impot Res 2010; 22:51.