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


To The Editor
Do Statins Prevent and Treat Infections - Or Is It High Cholesterol?
Meta-analysis of observational studies may show statistically significant associations between statins and reduced risk of infection1, but this does not demonstrate a causal relationship.  An alternate possibility is that the vast majority of subjects likely had hypercholesterolemia, which protects against infections, especially in the elderly, where risk of cardiovascular deaths and disease is the greatest, and where it is also associated with decreased coronary and all cause mortality.2 There is nothing to suggest that any putative statin antimicrobial activities are related to lipid lowering or pleiotropic effects such as blood thinning and reduction of inflammation.  With respect to the latter, there is growing evidence that coronary atherosclerosis begins as an inflammatory process, and that this is often due to bacterial and viral infections that can also create vulnerable plaque.3 Stress can contribute to coronary heart disease via varied mechanisms and this suggests an additional pathway, since the ability of stress to increase susceptibility to infections by effects on the immune system is well documented.4 In addition, the current goal of statin therapy, which is to lower LDL as much as possible or to an arbitrary level few can achieve, is not only inappropriate, but also dangerous.  This mandate necessitates administering larger doses for longer periods of time, both of which increase the incidence and severity of adverse statin side effects.  As previously suggested, statin anti-inflammatory benefits may be achieved by doses much lower than those required for other indications, as has been shown with aspirin.5


1. Tleyjeh IM, Kashour T, Hakim FA,  Zimmerman VA, Erwin PJ,  Sutton AJ, Ibrahim T. Statins for the Prevention and Treatment of Infections: A Systematic Review and Meta-analysis. Arch Intern Med. 2009;169(18):1658-1667.

2. Ravnskov U. High cholesterol may protect against infections and atherosclerosis. Q J Med 2003;96:927-934.

3. Ravnskov, U.; McCully, K.S. Review and Hypothesis: Vulnerable plaque formation from obstruction of Vasa vasorum by homocysteinylated and oxidized lipoprotein aggregates complexed with microbial remnants and LDL autoantibodies. Ann. Clin. Lab. Sci. 2009;39:3-16.

4. Rosch, PJ.  Forget About Fat and Cholesterol! It's Stress That Causes Heart Disease. Psychologie in Österreich. 2009;1:26-33.

5. Rosch, PJ. Guidelines for Diagnosis and Treatment of High Cholesterol. JAMA  2001;286:2401-2402.

Sincerely yours,
Paul J. Rosch, MD, FACP
Clinical Professor of Medicine and Psychiatry
New York Medical College
President, The American Institute of Stress
124 Park Ave. Yonkers, NY 10703

And here comes the editor´s usual response:

October 24, 2009

Dr. Paul Rosch
New York Medical College
Medicine and Psychiatry
124 Park Ave.
Yonkers, NY 10703

Dear Dr. Rosch:

Thank you for your recent letter to the editor. Unfortunately, because
of the many submissions we receive and our space limitations in the
Letters section, we are unable to publish your letter in Archives of
Internal Medicine.

After considering the opinions of our editorial staff, we determined
your letter did not receive a high enough priority rating for
publication in Archives of Internal Medicine. We are able to publish
only a small fraction of the many letters submitted to us each year,
which means that published letters must have an extremely high rating.

We appreciate your interest and thank you for the opportunity to look at
your letter.


Rita F. Redberg, MD, MSc
Editor, Archives of Internal Medicine

Other unpublished contributions by members of THINCS