–“We are losing the battle for the hearts and minds of our patients.”
A leading cardiologist has unleashed a blistering attack on “statin denial,” which he calls “an internet-driven cult with deadly consequences.”
In an editorial in Annals of Internal Medicine, Steve Nissen (Cleveland Clinic) expresses grave concerns over statistics showing that only 61% of people given a prescription for a statin were adherent at 3 months. “For a treatment with such well-documented morbidity and mortality benefits, these adherence rates are shockingly low. Why?” he asks.
Nissen writes that “we are losing the battle for the hearts and minds of our patients to Web sites developed by people with little or no scientific expertise, who often pedal ‘natural’ or ‘drug-free’ remedies for elevated cholesterol levels.” The anti-statin forces employ two distinct strategies, “statin denial, the proposition that cholesterol is not related to heart disease, and statin fear, the notion that lowering serum cholesterol levels will cause serious adverse effects.” Nissen admits that some patients will have statin-related adverse effects but “intolerance in many patients undoubtedly represents the nocebo effect.”
Outcomes After Adverse Reactions
The editorial accompanies a study from Brigham and Women’s Hospital looking at what happened to 28,266 people who reported an adverse reaction to statin therapy. 70.7% continued to receive statin prescriptions after reporting the adverse reaction. After four years the rate of cardiovascular events was 12.2% in those who continued to receive statin prescriptions versus 13.9% in those who did not.
“Statins remain a first-line therapy for managing cardiovascular risk, but many patients do not reattempt statin therapy and remain without treatment for prolonged periods after an adverse reaction,” said Alexander Turchin, senior author of the paper, in a press release. “Alternative therapies such as ezetimibe are not as effective, and new classes of drugs are expensive. Improving our understanding of the benefits and risks of reattempting statin therapies before switching to a different class of drugs could help both patients and physicians make informed choices about care.”
The authors acknowledged that because it was a retrospective study they “could establish only associations rather than causal relationships.” In his editorial, Nissen acknowledged these limitations but said the study is “reasonably convincing: Discontinuing statin treatment has serious negative consequences.”
How Did We Get Here
Nissen places a substantial portion of the blame for statin denialism on the Dietary Supplement Health and Education Act of 1994 (DSHEA), which loosened regulation of dietary supplements, spurring what is now a $30 billion a year industry selling an “array of worthless or harmful dietary supplements.” According to Nissen, supplement makers “commonly imply benefits that have never been confirmed in formal clinical studies.” Nissen singled out Dr. Oz for an article, “Reverse Your Heart Disease in 28 Days,” that didn’t mention statins.
Responding to email questions, Nissen defended the use of statins in primary prevention, writing “we have abundant scientific evidence demonstrating that treatment of high risk primary prevention patients substantially reduces the risk of cardiovascular morbidity.” He acknowledged that statins, like other drugs, have adverse effects, “but the benefits are so well documented that every effort should be made to encourage use of these drugs in appropriate patients. The diversion of patients away from evidence-based therapy by advocates of unproven dietary supplements must be vigorously opposed by physician-scientists. Similarly, the claims that cult diets can reverse heart disease have no scientific basis and represent a danger to public health.”
James Stein (University of Wisconsin), expressed strong support for Nissen’s editorial. “I have scores of patients who stop their statins based on fears that mainly come from the internet, though I have to say, ‘friends’, pharmacists, and many primary care docs play into the fears. We spend a lot of time trying to sort out various aches and pains, non-specific symptoms, and anxieties that are not due to statins. Many lives have been lost or impaired because of statin non-compliance. There is a special place in hell for people who use fear tactics and misinformation to promote books and natural health aids, including crazy diets, at the expense of proven medical therapies, rather than as complimentary options under medical direction. I am not sure why Americans are so susceptible to these charlatans.”
My GP tried to impress me aboard the good ship Statinator even though my cholesterol readings had been fine for decades, and an angiogram had shown the relevant arteries to be “clean as a whistle” (the technical term used by the cardiologist).
Meantime my friend The Retired Epidemiologist had remarked that far more of his friends were suffering from the adverse side effects of statins than the literature had encouraged him to think likely.
He won’t take statins either.
How about the role of science in discontinuing satins, whoops, statins. How long can these guys ignore the science supporting the marginal benefits these harmful drugs deliver? Blaming the internet is disingenuous at best: try blaming knowledge.
Thanks for bringing this to my attention.
Kudos to Steve Nissen for speaking out on this madness.
I will repost portions of this including Jim Stein’s comments on my blog if OK with you.
sure, go ahead.
If statin denialism is an internet-driven cult, what the heck is statin worship? Sounds like a cult to me….
1) How much is he being paid to say this? As much as Tom Dayspring, or Professor Lord Sir Rory Collins in the UK?
2) I accept the statin reduced my LDL, but stopping my low fat diet DOUBLED my HDL and reduced my trigs to 1/10 of what they were. On a scale of 1 to 10 which has more benefit? Much research now into dietary factors producing much better results through more convincing pathways.
3) “Web sites developed by people with little or no scientific expertise” does that include PubMed?
4) Becoming hyperthyroid reduced my LDL by as much as a statin. Is this a recommended way to reduce my CVD risk? I think not.
5) NNT! How much is being spent on not achieving much, if anything at all?
Try your hand at the Statin Casino ( Visual presentation ) :
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800759/figure/OPENHRT2015000343F3/
How can someone who wants to be treated in a respectful manner refer other people with a different approach to statins as “people with little or no scientific expertise”?
Promoting a drug like statins as primary prevention instead of changing lifestyles and check for atherosclerosis is denying a basic principle of Hipocrates “Let food be thy medicine and medicine be thy food.” and ignoring that high cholesterol without plaque isn’t a problem…
I strongly recommend this documentary “Cholesterol, The Great Bluff”
I am not sure why Americans are so susceptible to these charlatans. Answer: (1) People want an easy way out of any problem. (2) There is a growing distrust that medical directions, may be based only the financial gain of the prescribers. (3) After the introduction of every drug, a barrage of lawyer commercials follow, all talking about everything the drug company hid from the public. (4) Many view the use of a drug as helping 1 problem, while creating several new ones.(5) The price of drugs.
I enjoyed this comment at Dr Kendrick’s blog.
“Nissen has manage to get in the full set of insults. ‘Denier’, ‘cult’, ‘deadly’, ‘whips up’, ‘fears’, ‘profit from selling snake oil’. What’s missing? Mass murderers…child killers.
Would this be the same Steven Nissen who stated the following, when the new cholesterol guidelines came out in 2013
“The science was never there for the LDL targets.’ He said. ‘Past committees made them up out of thin air.’
Make your mind up Steven. Either there should be LDL targets or not.”
https://drmalcolmkendrick.org
Dr. Nissen should go and examine statistical data from countries that have socialized medicine. The gov’t knows exactly how many are using statins and how many are having heart disease related events. Referencing USA based studies that are faulty in one respect or another is downright silly when actual raw data is readily available. Statins have been used since about 1987 so there is substantial hard data available from actual use. Examining that data will give you a true picture and put this discussion into the circular file.
Let’s face it: Nielsen’s wrote up on satins is just an emotional tirade that is supposed to weigh in for the facts. Silly paper.
The problem is there is not one place to go if you have adverse reactions.also most men do not think about muscle pains as being caused by a drug.they blame it on exercise ,old age,etc. So never talk to dr. About pain. Then when you do talk to Dr.,they only keep typing on laptop,can give you other statin with “less side effects “. They do nothing to try to reverse the problem. From what I have learned,there is NO reversal or cure.just more drugs with different side effects.
I am currently on Zetia. I was previously on statins for almost 10 years. I am still suffering daily from terrible back and leg pain. Nothing has helped except for physical therapy, which helps some, but the pain still comes back. I’d really like to know if there are any options besides statins that provide cholesterol lowering, yet eliminate leg and back pain. FYI, I changed my diet and lost 40 pounds and still my leg and back pain continues. Thank you.
I haven’t read the study quoted that stated those with a prescription for a statin had a better outcome than those who did not….but maybe some of those people like my boyfriend just collected the prescription but never took the tablets. I had to call time when our cupboard was overflowing. All due to dr not believing side effects due to statins. You guessed it, side effects disappeared. Maybe if the number of people like my boyfriend were moved to the other group that might show not taking the tablets have a better outcome?