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

To 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.

Leslie M. Klevay, M.D., S.D. in Hyg. 
University of North Dakota School of Medicine & Health Sciences Grand Forks, ND, 58202  

1. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352:1425-35. 
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 2002; 288:2998-3007.
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.

Editor’s response:

Dear Dr. Klevay,

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.

Sincerely yours,

Gregory D. Curfman, M.D.
Executive Editor
New England Journal of Medicine

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