This is a contribution from a member of THINCS,
The International Network of Cholesterol Skeptics

Letter to the editor of New England Journal of Medicine, sent 26. April 2004

To the editor:

Dr. Topol’s editorial suggests that simvastatin demonstrated improved survival in the 4S study (ref. 1 in 1); there were however 2 more dead women in the statin group. The simvastatin mortality difference for women in the Heart Protection Study (ref. 4 in 1) was also not significant -in fact, no statin trial to date shows improved survival in women (2).  
The largest simvastatin study was the 6 year J-LIT trial where, in 41,801 hypercholesterolemic Japanese, groups attaining minimal cholesterol levels, <160 and 170±10 mg/dL, had over double the mortality rates of those at 240±20 mg/dL (3).

   Not mentioned are trials showing no mortality difference, like PROSPER, ASCOT and ALLHAT, or EXCEL that ended with a nonsignificant 2.75x greater mortality, versus placebo, in the lovastatin groups. PROSPER ended with 28 fewer cardiac but 24 more cancer deaths (despite 52 fewer smokers) in “elderly” on pravastatin. 
               Contrary to what one might conclude from the editorial, these data suggest that survival benefits from statins are not proven in groups that include women, “elderly” and hypercholesterolemics without heart disease.

 Eddie Vos, M Eng (corresponding)           Peter H. Langsjoen M.D.
127 Courser Road                                    East Texas Medical Center
Sutton (Qc) Canada JOE 2K0                   Tyler TX 75701 USA

Tel. & fax: 1 (450) 538 0465

 1. Topol EJ. Intensive Statin Therapy –A Sea Change in Cardiovascular Prevention  NEJM 2004;350:1562-4   PMID 15007111

2. Jenkins AJ. Might money spent on statins be better spent? 
BMJ 2003;327:933 PMID: 14563776

3. Matsuzaki M, Kita T, Mabuchi H et al. Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia. Circ J. 2002 66(12):1087-95. PMID: 12499611

Editor´s answer:

Dear Mr. Vos,

I am sorry that we will not be able to print your recent letter to the editor regarding the Topol editorial of April 8.  The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received.  Many worthwhile communications must be declined simply for lack of space.

Sincerely yours,

Gregory D. Curfman, M.D. 
Executive Editor 
New England Journal of Medicine

Eddie Vos´ response:

Dear Dr. Curfman, We respect your decision not to publish our letter to the Editor despite the fact that it addresses a major misunderstanding regarding the established value of statin drugs. We trust that other published letters shall appropriately address this issue. I cc Dr. Topol regarding our letter submission. 
Kind regards, 

Eddie Vos


No letters were published with similar objections.