Might the beneficial effects of statin drugs be related to their action on iron metabolism?

Although the cholesterol-heart hypothesis is often regarded as a dogmatic belief, controversy continues to surround the aetiology and pathogenesis of atherosclerosis. In fact, lowering cholesterol with statin drugs has been shown to reduce cardiovascular risk. However, statins have pleiotropic effects independent of their capacity to lower cholesterol. We highlight that statin drugs exert an important action on iron metabolism, which in turn may prevent progression and destabilization of atherosclerotic plaque. If it is found that the effect of statins on iron metabolism is a mechanism of their beneficial action, this consequence of statin use can be clinically replicated by other methods, such as controlled reduction of body iron stores. This might allow the use of lower doses or even obviate the use of statins in primary cardiovascular prevention, and therefore avoid the side effects and expense of these drugs.

Surgery and cancer promotion: are we trading beauty for cancer?

It is well-known that cancer surgery can actually promote the growth of some tumors by a variety of mechanisms. There are observational data suggesting that surgery per se can increase the risk of cancer among individuals without a history of clinical cancer. Occult microscopic cancers are exceedingly common in the general population and are held in a dormant state by a balance between cell proliferation and cell death and also an intact host immune surveillance. The catecholamine surge from the stress of surgery and resulting ß(2)-adrenergic signaling culminates in a transient and robust increased vascular endothelial growth factor expression locally and systemically that is enough to start tumor angiogenesis and end dormancy. The same catecholamine surge and ß(2)-adrenergic signaling impairs cell-mediated immunity at a crucial time. Elegant animal studies have demonstrated that perioperative nonselective ß-blockade abrogates surgical stress-induced angiogenesis and tumor growth. Prospective human trials are desperately needed and clinical implications are discussed.