Evaluation of the effect of genetic variation on the relationship between statins, cardiovascular disease and cancer.

Statins are a class of medications that are competitive inhibitors of Hydroxy Methyl Glutaryl Co-enzyme A (HMG-CoA) reductase which is the rate-limiting enzyme in the cholesterol bio-synthesis pathway. As a result, statins lower total cholesterol and low density lipoprotein (LDL) cholesterol thus impacting cardiovascular mortality. The downstream effects of statins are not limited to inhibition of cholesterol synthesis alone. Statins have anti-inflammatory effects thought to be important in the setting of acute myocardial infarction which also may be a mechanism involved in anti-carcinogenic properties of statins. Furthermore, statin inhibition of the mevalonate pathway may impact Ras and RhoGTPases that are important in cell proliferation, migration and apoptosis. These alterations may also play a role in the anti-cancer effect of statins. In this article we will review the literature on how genetic variation modifies the effect of statins on the risk of cardiovascular disease and how genetic variation may impact the relationship between statins and the risk of a number of different cancers.