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(Circulation. 2000;101:e89.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

The Nature of the Statins

Peter H. Jones, MD

Associate Professor Section of Atherosclerosis and Lipoprotein Research, Department of Medicine, Baylor College of Medicine, Houston, Tex

	Introduction

 
To the Editor:

In his editorial,¹ Furberg cites CURVES² as demonstrating that atorvastatin "unfavorably influences" HDL cholesterol (HDL-C) concentrations. In fact, atorvastatin 10 to 40 mg/d increased HDL-C 4.8% to 5.5%, typical for a statin. In a much smaller group, atorvastatin 80 mg/d did not affect HDL-C levels.² The sample size (10 patients) raises questions, because HDL-C response with statins as a class can vary; larger trials of atorvastatin 80 mg/d demonstrated significant increases (7% to 26%).^{3 4} Furberg also states that with proper dose titration, the "natural statins" achieve LDL cholesterol (LDL-C) reductions similar to those of atorvastatin. In CURVES, atorvastatin 10 mg once daily was better at LDL-C lowering than any single daily dose of fluvastatin, lovastatin, pravastatin, or simvastatin except simvastatin 40 mg. Atorvastatin 20 mg once daily was better than all single daily doses of the other agents.

I believe the term "natural statins" is inexact and should not be adopted. Although lovastatin and pravastatin are fungal derivatives, simvastatin is semisynthetic. While one might call any plant-derived compound "natural," one should carefully define the meaning to avoid misinterpretation. There may be the implication, as exploited by the alternative medicine industry, that synthetic drugs have detrimental effects that would not be expected from "natural" products. "Natural" may also imply that over-the-counter products such as Cholestin, which contains lovastatin, may be taken without physician supervision.

Furberg emphasizes that the "natural statins" were the agents used in the published clinical end-point trials. More exactly, lovastatin, pravastatin, and simvastatin are the . . . [Full Text of this Article]

Curt D. Furberg, MD, PhD

Professor Department of Public Health Sciences, Wake Forest University, School of Medicine, Winston-Salem, NC