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This
is a contribution from a member of THINCS, To the Editor of New England Journal of Medicine: The review
by Hiatt (May 24 NEJM)1 on the preferred treatment of peripheral
arterial disease and claudication contains some apparent misunderstandings.
Since cholesterol levels as low as 100 mg/dL are strongly associated with
higher cancer rates, and high cholesterol levels, although correlated with
atherosclerosis since 1913, have not been proven to cause it,2
Hiatt's recommendation to strive for very low cholesterol levels is
misdirected. While statin drugs certainly lower cholesterol levels, a
surrogate endpoint, three of the studies did not lower total mortality
significantly, a hard endpoint, and earlier cholesterol drugs, such as
cholestyramine and colestipol, and even early trials of lovastatin showed
higher death rates; moreover, some statin drugs increased breast cancer
rates in women.3 In reviewing the use of aspirin, Hiatt
seems unaware that the Physicians Health Study used aspirin containing
calcium and magnesium, and that overall death rates were almost the same as
for placebo. Where plain aspirin was used in another equally
well-controlled trial the overall death rate was slightly higher than for
the subjects on placebo.4 Hiatt dismissed the utility
of EDTA-chelation treatments (his ref. 116); but a different review has
solid evidence of the effectiveness of chelation in 87% of patients (r =
0.88), and an explanation for a number of the trials that showed little
effect.5 Because of its misunderstandings and omissions,
this review cannot be considered authoritative. Joel M. Kauffman, Ph. D. University of the Sciences in Philadelphia,
Philadelphia, PA 19104
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