This is a
contribution from a member of THINCS,
The International Network of Cholesterol Skeptics
sent to the editor of New England Journal of Medicine commenting a new
statin trial, where the lower number of cardiovascular deaths was balanced
by anincreased number of deaths by other causes, mainly cancer.
the Editor: La Rosa et al. (April 7 issue)(1) evaluated
effects of lipid lowering with atorvastatin ( 80 vs. 10 mg daily for
nearly 5 years) in patients with stable coronary disease.
Who benefits when intensive treatment merely changes the words (but
not the date) on the death certificates?
This is not the first anti-cholesterol experiment to end this way
(2-5); it probably will not be the last.
M. Klevay, M.D., S.D. in Hyg.
University of North Dakota School of Medicine & Health Sciences Grand
Forks, ND, 58202
LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with
atorvastatin in patients with stable coronary disease. N Engl J Med
2. Committee of Principal Investigators. WHO cooperative trial on primary prevention of ischaemic
heart disease with clofibrate to lower serum cholesterol: final mortality
follow-up. Lancet 1984; 2:600-4.
3. ALLHAT Officers.
Major outcomes in moderately hypercholesterolemic, hypertensive
patients randomized to pravastatin vs usual care: The antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA
4. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly
individuals at risk of vascular disease (PROSPER): a randomised controlled
trial. Lancet 2002; 360:1623-30.
5. Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke
events with atorvastatin in hypertensive patients who have average or
lower-than-average cholesterol concentrations, in the Anglo-Scandinavian
Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre
randomised controlled trial. Lancet 2003; 361:1149-58.
I am sorry that we will not be able to print your recent letter to the
editor regarding the LaRosa article of April 7. 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.
Gregory D. Curfman, M.D.
New England Journal of Medicine
Other unpublished contributions