The following letter was sent to the editor of Wall Street Journal on May 25, 2003. No answer.
Dear WSJ Editors:
Statin Sales Slow
An article in today's WSJ by Scott Hensley, "The Statin Dilemma: How Sluggish Sales Hurt Merck, Pfizer, 25 Jul 03, ppC1,C3, is of great value to investors like me. However, there was a serious bit of misinformation: "...the medical evidence continues to mount that more people — not fewer — should be taking the drugs."
While it is true that some short-term uses may have some minor benefits, the association between statins and lowered coenzyme Q10 levels leading to congestive heart failure has been noted for 15 years. Far from lowering all-cause mortality, the EXCEL and AFCAPS/TexCAPS trials (both lovastatin) demonstrated increased mortality in the treatment groups. In the CARE trial the breast cancer rate went up 1500 %. In the PROSPER trial (pravastatin) the all-cause death rate was unchanged, with cardiovascular deaths reduced and cancer and stroke deaths increased. In the ALLHAT trial pravastatin did not reduce either all-cause mortality or heart disease after 5 years. The other trials showing slightly less all-cause mortality have not been run for the 20-50 year periods often recommended for patients to take statin drugs, and the side-effects (congestive heart failure, rhabdomyolysis, polyneuropathy, amnesia) are not yet fully appreciated, except for the patients signing up for the class-action lawsuits. Because of the non-cause by high total cholesterol levels of atherosclerosis and coronary heart disease, it is not advisable to lower cholesterol levels by any direct means (Ravnskov U. Is atherosclerosis caused by high cholesterol? Q J Med 2002;95:397-403). This has been known for years (Allred J. Lowering Serum Cholesterol: Who Benefits? J Nutr 1993;123:1453-9).
Even for short-term use (16 weeks in the MIRACL study) in patients with heart or angina problems, use of atorvastatin (Lipitor™) at a rich 80 mg/day did not change the all-cause death rate or the rate of heart attacks by a significant amount (Schwartz GG et al., Effects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndromes. J Am Med Assoc 2001;285:1711-8).
Long-term use of statins for primary prevention of heart disease produced a 1 % greater risk of death over 10 years vs.placebo when the results of all the big controlled trials reported before 2000 were combined (Jackson PR et al. Statins for primary prevention: at what coronary risk is safety assured? Br J Clin Pharmacol 2001;52:439-46).
Could it be that this type of information, available in the internet, not to mention the side-effects of the statins, is slowing the use of the statin drugs?
M. Kauffman, Professor of Chemistry Emeritus, USP