is a contribution from members of THINCS,
The International Network of Cholesterol Skeptics
To The Editor
Statins Prevent and Treat Infections - Or Is It High Cholesterol?
Meta-analysis of observational studies may show statistically significant
associations between statins and reduced risk of infection1, but
this does not demonstrate a causal relationship.
An alternate possibility is that the vast majority of subjects likely
had hypercholesterolemia, which protects against infections, especially in
the elderly, where risk of cardiovascular deaths and disease is the greatest,
and where it is also associated with decreased coronary and all cause
mortality.2 There is nothing to suggest that any putative statin
antimicrobial activities are related to lipid lowering or pleiotropic
effects such as blood thinning and reduction of inflammation.
With respect to the latter, there is growing evidence that coronary
atherosclerosis begins as an inflammatory process, and that this is often
due to bacterial and viral infections that can also create vulnerable
plaque.3 Stress can contribute to coronary heart disease via
varied mechanisms and this suggests an additional pathway, since the ability
of stress to increase susceptibility to infections by effects on the immune
system is well documented.4 In addition, the current goal of
statin therapy, which is to lower LDL as much as possible or to an arbitrary
level few can achieve, is not only inappropriate, but also dangerous.
This mandate necessitates administering larger doses for longer
periods of time, both of which increase the incidence and severity of
adverse statin side effects. As
previously suggested, statin anti-inflammatory benefits may be achieved by
doses much lower than those required for other indications, as has been
shown with aspirin.5
1. Tleyjeh IM, Kashour T, Hakim FA,
Zimmerman VA, Erwin PJ, Sutton
AJ, Ibrahim T. Statins for the Prevention and Treatment of Infections: A
Systematic Review and Meta-analysis. Arch
Intern Med. 2009;169(18):1658-1667.
2. Ravnskov U. High cholesterol may protect against
infections and atherosclerosis. Q J Med 2003;96:927-934.
3. Ravnskov, U.; McCully, K.S. Review and Hypothesis:
Vulnerable plaque formation from obstruction of Vasa vasorum by
homocysteinylated and oxidized lipoprotein aggregates complexed with
microbial remnants and LDL autoantibodies. Ann.
Clin. Lab. Sci. 2009;39:3-16.
4. Rosch, PJ. Forget
About Fat and Cholesterol! It's Stress That Causes Heart Disease. Psychologie
in Österreich. 2009;1:26-33.
5. Rosch, PJ. Guidelines for Diagnosis and Treatment
of High Cholesterol. JAMA
Paul J. Rosch, MD, FACP
Clinical Professor of Medicine and Psychiatry
New York Medical College
The American Institute of Stress
124 Park Ave. Yonkers, NY 10703
And here comes the editor´s
New York Medical College
Medicine and Psychiatry
124 Park Ave.
Yonkers, NY 10703
Dear Dr. Rosch:
Thank you for your recent letter to the editor. Unfortunately, because
of the many submissions we receive and our space limitations in the
Letters section, we are unable to publish your letter in Archives of
After considering the opinions of our editorial staff, we determined
your letter did not receive a high enough priority rating for
publication in Archives of Internal Medicine. We are able to publish
only a small fraction of the many letters submitted to us each year,
which means that published letters must have an extremely high rating.
We appreciate your interest and thank you for the opportunity to look at
Rita F. Redberg, MD, MSc
Editor, Archives of Internal Medicine
unpublished contributions by members of THINCS