[Immunomodulatory properties of statins and cancer risk]

Statins are cholesterol-lowering drugs widely prescribed for cardiovascular prevention. They are also immunomodulatory and increase peripheral regulatory T cell numbers and function, in vivo. This may be beneficial by decreasing inflammatory response within the atheroma and stabilizing atherosclerotic plaque, however this novel pleiotropic effect might impair host tumor-specific effector T cell responses. Indeed, in some randomized trials, notwithstanding their short duration, statins have been found to increase cancer incidence especially in the elderly and women. In these situations, the decrease in cardiovascular mortality can be matched by an equal increase in cancer mortality, leaving all-cause mortality unchanged. Furthermore, statins have been shown to interfere with cancer immunotherapy. Preventive pharmacological treatment can sometimes be justified because of reduced cardiovascular events even if total mortality does not change, but if it leads to an increase in cancer incidence, it might be not easily accepted. Physicians need to weigh the global risks and benefits when prescribing statins.