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This
is a contribution from a member of THINCS,
The International Network of Cholesterol Skeptics
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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 (www.thincs.org
)
Magle Stora Kyrkogata 9, S-22350 Lund, Sweden
References
1.
McKillop T. The statin wars. Lancet 2003; 362: 1498.
2.
Ravnskov U. High cholesterol may protect against infections and
atherosclerosis. QJM in press.
3.
Ravnskov U. Is atherosclerosis caused by high cholesterol? QJM
2002;
95: 397-403.
4.
The International Network of Cholesterol Skeptics. About low-dose
statin treatment.
www.thincs.org/discuss.lowdose.htm
The Editor´s answer
19
November, 2003
THE
LANCET, EDITORIAL
RICHARD HORTON Editor
ASTRID JAMES Deputy Editor
THE LANCET
32 Jamestown Road, London NW1 7BY UK
T) +44 (0) 207424 4910 F) +44 (0) 2074244911
E) editorial@lancet.com W) www.thelancet.com
AP/LC /03COR/11006
Dr Uffe Ravnskov
Internal Medicine and Nephrology
Magle Stora Kyrkogata 9
S-22350 Lund
Sweden
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
forum.
Yours sincerely
Zoe Mullan
Senior Editor
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