Cancer Risk Increased in Diabetes Patients with Low LDL Cholesterol and Albuminuria

Dr. Juliana C. N. Chan from The Chinese University of Hong Kong stated that, "These findings should not form the basis for a screening test for cancer but rather stimulate further research in this emerging area of therapeutic challenge, i.e., diabetes and cancer."

Dr. Chan and colleagues explored the interaction between low LDL cholesterol, albuminuria, and cancer risk in 3,793 statin-naive diabetics and 1,483 patients in whom statin treatment was initiated during a median follow-up of 5.2 years.

Patients who used statins were more likely to use other drugs and develop cardiovascular complications but less likely to have cancer and die, compared with patients who did not receive statin treatment, the authors report.

The presence of both LDL cholesterol < 2.80 mmol/L (approximately 110 mg/dl) and albuminuria was associated with a 3.1-fold increased risk of cancer, whereas the presence of only albuminuria or only LDL cholesterol < 2.80 mmol/L was not associated with an increased cancer risk.

This suggests that the previously reported increase in cancer risk among Type 2 diabetic patients with low LDL cholesterol is conditional on the presence of albuminuria, the investigators say.

Patients with low LDL cholesterol and albuminuria who did not use statins faced a 4.8-fold increased cancer risk, the researchers note, but patients with both risk factors who were treated with statins during follow-up did not have an increased cancer risk.

"From a clinical perspective, our findings should help to resolve the concerns regarding use of statins and cancer risk in Type 2 diabetes," Dr. Chan said. "Not only is statin use not associated with increased cancer risk, this drug appears to have protective effects against cancer in patients with high LDL-C level and those with dual presence of low LDL-C and renal dysfunction."

"These observations are not causal but suggest complex interplays between lipid and growth promoting pathways which may be dependent on renal function," Dr. Chan concluded.

Diabetes Care 2009;32:1826-1832.