Stavros Antonopoulos1, Sotiris Mikros1, Stelios Kokkoris1*, John Protopsaltis1, Konstantina Filioti1, Dimitrios Karamanolis2 and Grigorios Giannoulis1
1Second Department of Internal Medicine and 2Department of Gastroenterology, ‘Tzanio’ General Hospital of Piraeus. Athens, Greece
Received June 13th, 2005
Anticholesteremic Agents; Cardiovascular Diseases; Pancreatitis
NCEP-ATP: National Cholesterol Education Program Adult Treatment Panel
We read with great interest the letter from Dr. Singh  and we appreciate his comments. First of all, we would like to stress that our patient belonged to the category of very high risk patients for cardiovascular disease, according to Grundy et al. , because he was suffering from coronary heart disease and had two additional major risk factors, such as diabetes mellitus and arterial hypertension . According to the Framingham risk score classification, his 10-year risk for hard coronary heart disease was much higher than 20% . The National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) strongly recommends that such patients be treated with statins so that the LDL cholesterol level drops below 100 mg/dL . Moreover, newer data indicate that when the risk is very high, an LDL cholesterol goal of less than 70 mg/dL must be a therapeutic option . On the other hand, we agree that our patient was at greater risk for a recurrence of pancreatitis. However, to date, it has not been well-established that pancreatitis is a class effect of statins. Furthermore, the risk of pancreatitis due to rosuvastatin is less than 1% . In contrast, the risk of cardiovascular disease, as mentioned above, would be much higher if our patient remained without a lipid lowering drug.
Taking all of this into consideration, we decided that our patient should continue receiving a statin, because reducing the risk of cardiovascular disease counterbalanced the risk of pancreatitis recurrence.