Sian Claire Owen, Medical Journalist for Cardio Debate

The rise of ‘statin deniers’ – an online movement denouncing the use of statins to reduce cholesterol – is causing havoc in patients at risk of developing CVD, according to leading cardiologist Steve Nissen, Cleveland Clinic, Ohio, US.

In an editorial published in the Annals of Internal Medicine he describes ‘statin deniers’ as ‘an Internet driven cult with deadly consequences,’ and writes that: ‘We are losing the battle for the hearts and minds of our patients to websites developed by people with little or no scientific expertise, who often pedal ‘natural’ or ‘drug free’ remedies for elevated cholesterol levels.” [1]

The anti-statin movement that Nissen describes is a result of the booming dietary supplement industry which is poorly regulated in the US. [2] They question established schools of thought that cholesterol is directly linked to heart disease, and that lowering cholesterol will result in ‘serious adverse side effects.’ [2]

However, a recent cohort study carried out by researchers from the Peking Union Medical College Hospital, Beijing, China, Harvard Medical School, Bringham Women’s Hospital, and the Baim Institute for Clinical Research, Boston, Massachusetts, analysed the continuation of statin prescriptions in patients who had experienced side effects. [3] Of the 28,266 people included in the study, 70.7 per cent continued to receive statin therapy after reporting an adverse event. Four years on, and the rate of CV events was 12.2 per cent in those who continued with statin therapy verses 13.9 per cent in those who did not. [3]

This debate has been ongoing for a long time, and although the value of statins should not be in doubt, there is another side to the coin and legitimate questions do need answering. Some of these were outlined by Fiona Godlee, editor-in-chief of the British Medical Journal in 2016 in her letter ‘Lessons from the controversy over statins’ that was published in The Lancet. [4] These include:

  • How large is the benefit of statin therapy for those at the lowest risk of heart disease?
  • Does the evidence represent different patient populations – such as women – adequately?
  • What is the impact of statin therapy on the patient’s lifestyle? Does it cause them to adopt more heathy behaviours, or the opposite?
  • Do we need to examine the potential harm of statin therapy to ‘balance the books’?

It is worth noting that these questions are a far cry from the ‘statin denialism’ movement that shuns cholesterol-lowering therapy in favour of untested ‘natural’ remedies.

And as Richard Lehman writes in his blog for the BMJ: “Taking lifetime preventive medication is an individual choice and we need to be practical—and humble—in our approach to informing and supporting it. The true work of shared decision making has scarcely begun.” [5]