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

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.

1. Hiatt, W. R. Medical Treatment of Peripheral Arterial Disease and Claudication.  N Engl J Med 2001:344:1608-20.
2. Stehbens, W. E. Coronary Heart Disease, Hypercholesteremia, and Atherosclerosis I. False Premises and II. Misrepresented Data. Experimental and Molecular Pathology 2001:70:103-119, and 120-139.
3. Ravnskov, U. The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease,  New Trends Publishing, Washington, DC, 2000.
4. Kauffman, J. M.  Should You Take Aspirin to Prevent Heart Attack?  J Sci Exploration 2000:14:623-41.
5. Chappell, L. T., Janson, M.  EDTA Chelation Therapy in the Treatment of Vascular Disease.  J Cardiovasc Nurs 1996:10:78-86.

Joel M. Kauffman, Ph. D. University of the Sciences in Philadelphia, Philadelphia, PA 19104

[Hard copy mailed 19 Jun 01.]  215-596-8836 FAX 215-895-1100


Unpublished contributions