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
2. Jenkins AJ. Might money spent on statins be better spent?
BMJ 2003;327:933 PMID:
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.
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
Many worthwhile communications must be declined simply for lack of
Gregory D. Curfman, M.D.
New England Journal of Medicine
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.
letters were published with similar objections.