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

Letter to the editor of Lancet, sent 2. November  2003

Low-dose statin may be better
As neither long-term safety or clinical benefit have been documented for AstraZeneca´s new statin Crestor (rosuvastatin), the main argument for its use has been its impressive effect on the concentration of LDL cholesterol in the blood. Chief executive of AstraZeneca Tom McKillop admits that cholesterol is a surrogate event; yet he considers it an appropriate target for treatment because “large studies have established that an increased concentration of LDL cholesterol is a risk factor for the development of atherosclerosis”.1 However, at least seventeen cohort studies including almost 30 000 individuals have shown that high cholesterol is not a risk factor for cardiovascular disease in old people and may even predict longevity.2 This observation has mostly been considered as an annoying, but minor exception from the LDL-receptor hypothesis. Considering that more than 90 percent of all cardiovascular disease appear in people above age 60 it is in fact one of the most serious blows against it. In accordance, no study have found an association between the cholesterol concentration in the blood, measured before or after death, and degree of atherosclerosis at autopsy,2 and with one exception no observational angiographic study, and no angiographic or clinical cholesterol lowering trial has found dose-response, eg. an association between individual changes of cholesterol and clinical or angiographic outcome.2 3 These findings clearly indicate that the benefit from statin treatment has nothing to do with cholesterol. Instead of lowering cholesterol as much as possible a better goal might therefore be to find the lowest, effective statin dose.4 

Uffe Ravnskov; MD, PhD; independent researcher
Spokesman for THINCS , The International Network of Cholesterol Skeptics ( )

Magle Stora Kyrkogata 9, S-22350 Lund, Sweden

McKillop T. The statin wars. Lancet 2003; 362: 1498.
Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM in press.
Ravnskov U. Is atherosclerosis caused by high cholesterol? QJM 2002; 95: 397-403.
The International Network of Cholesterol Skeptics. About low-dose statin treatment.  

The Editor´s answer

19 November, 2003

ASTRID JAMES Deputy Editor
32 Jamestown Road, London NW1 7BY UK
T) +44 (0) 207424 4910  F) +44 (0) 2074244911
AP/LC /03COR/11006

Dr Uffe Ravnskov
Internal Medicine and Nephrology
Magle Stora Kyrkogata 9
S-22350 Lund

Dear Dr Ravnskov,

Thank you for your communication on Low-dose statin may be better, which you
sent for publication in our Correspondence columns. I'm afraid we have
decided not to accept your letter for publication on this occasion. Well
over 3000 letters are submitted every year, and our criteria for acceptance
are therefore very stringent. I wish you luck with acceptance in another

Yours sincerely

Zoe Mullan
Senior Editor