Viagra + Statin, blocking the cholesterol pathway from both sides

A design that blocks the pathway as well, once cancer cells begin synthesizing cholesterol directly as a compensatory response

Sildenafil

Blocking the import pathway

Blocks the release of cholesterol stored in lysosomes (NPC1 transport). The cell has inventory but cannot use it.

Statin

Blocking the production pathway

Inhibits HMG-CoA reductase to prevent de novo cholesterol synthesis. Neutralizes the SREBP2 compensatory response of cancer cells.

Clalit Cohort — Sildenafil/statin use and the reduction in 5-year mortality risk

Sildenafil monotherapy groupApprox. 26% ↓

Sildenafil + Statin combination groupApprox. 31~32% ↓

Caution when reading the numbers. The reason it is reported differently as 26%, 31%, and 32% by different media is that the comparison groups are different. "Compared to non-users" and "compared to those who used neither" are different calculations. Also, these figures are results from observational analysis of medical records, not randomized clinical trials, and the cancer stage at the time of diagnosis was not adjusted.