Dyslipidaemias in cancer patients

Dyslipidaemia in cancer patients presents several challenges with increasing survival of cancer patients. Dyslipidaemia and cancer treatments both increase atherosclerotic cardiovascular disease (ASCVD) risk; yet, most risk prediction scores for ASCVD do not include important cancer factors and thus underestimate true ASCVD. Some cancer therapies cause transient elevations of low-density lipoprotein cholesterol or triglycerides, or reduction in high-density lipoprotein cholesterol, occasionally to extreme levels requiring specific treatment and monitoring strategies. A range of lipid-lowering therapies can be used in cancer patients to manage cholesterol and triglycerides but of these, reliable data only exist for statins and ezetimibe for managing low-density lipoprotein cholesterol, and fibrates and Omega 3 fish oils for hypertriglyceridaemia. There are no robust randomized controlled trials conducted in cancer patients for reduction of adverse cardiovascular events and therefore current recommendations have been extrapolated from non-cancer trials. Cancer survivors may require combination therapies; yet, trials of newer lipid-lowering therapies excluded cancer patients and hence safety and efficacy data are limited. The initiation of lipid-lowering therapy in cancer patients requires an integration of several factors, which includes a careful assessment of ASCVD risk, drug-drug interactions, side-effect profiles, and prognosis. Further work is required to personalize individualized risk scores for ASCVD in cancer patients and survivors and new trials and 'real-world' or registry data would inform these existing data gaps. Beyond lipid management, the putative role of therapies such for statins as cardioprotective agent for anthracycline chemotherapy open novel avenues for further research as survival from many cancers continues to improve.