The nested case-control study by Dr Blais et al1 provided some reassurance regarding the safety of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. However, important issues remain unresolved.
In their cohort of older beneficiaries of a health care plan, those treated with HMG-CoA reductase inhibitors were less likely to be diagnosed as having cancer than those treated with bile acid sequestrants. Because the median period of follow-up for the cohort was only 2.7 years, this study does not offer long-term reassurance. Neoplasia from carcinogens can take decades to clinically manifest.2 This is not as important in older individuals at high risk for coronary events because neoplasia from the drug might not clinically manifest in their lifetime, whereas protection from coronary events should occur rapidly.3 However, in younger individuals HMG-CoA reductase inhibitors are potentially administered for decades, and there is a possibility for neoplasia from the drug to manifest during their lifetime.