Steven Nissen, MD, controversies in cardiology

What do you know about the popular cholesterol-lowering drugs known as statins? Are they miracle medicines that save lives, or do they represent a menace to health because of possible side effects? Get the truth on statins and heart disease.

Two Views on Statins:

We speak with two experts on statins and heart disease to get to the heart of the matter. They have different perspectives on the value of statins, but their views on what else we should be doing to protect our hearts are not as divergent as you might imagine.

Pros and Cons of Statins:

Find out about the pros and cons of statins so you can determine if one of these drugs is appropriate for you. In addition to learning about statins and heart disease, you’ll also learn about other approaches you can take to keep your heart as healthy as possible. You’ll also find out how to judge your risk of heart disease through the Reynolds Risk Score that Dr. Nissen recommends or the American Heart Association/American College of Cardiology Cardiovascular Risk Calculator. He also suggests shared decision-making between doctor and patient to determine when a statin is appropriate.

This Week’s Guests:

Steven Nissen, MD, is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. He is the co-author, with Mark Gillinov, MD, of Heart 411: The Only Guide to Heart Health You’ll Ever Need. Dr. Nissen’s most recent publications cover cholesterol-lowering drugs other than statins. They have been published in the American Heart Journal, Dec., 2015; European Heart Journal, May 1, 2016; Clinical Cardiology, March, 2016; JAMA, Apr. 19, 2016; American Heart Journal, June, 2016; and the American Journal of Cardiology, June 15, 2016. The photo is of Dr. Nissen.

David M. Diamond, PhD, is a professor in the Departments of Psychology and Molecular Pharmacology and Physiology at the University of South Florida. He is affiliated with the Center for Preclinical and Clinical Research on PTSD. He is director of the USF Neuroscience Collaborative and a research career scientist at the J. A. Haley Veterans Hospital. His recent articles have been published in Expert Review of Clinical Pharmacology, March, 2015, and BMJ Open, June 12, 2016.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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Air Date:July 30, 2016

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  1. David Diamond
    Tampa, FL
    Reply

    The Graedons have been criticized for inviting me to express my views on their program, and yet, not a single critic cared to read the papers that were cited in the podcast that I published on the topic. To their credit, the Graedons invited me to provide my input based on my publications in peer-reviewed medical journals. I want to to thank them for giving me a forum for presenting accurate research-based information on heart disease, cholesterol and statins. To those individuals who criticized me and my views, here and in an op-ed elsewhere (http://www.newsobserver.com/opinion/op-ed/article93997317.html), I have provided a rebuttal at my home website. Once you read the rebuttal, with its extensive literature links, I welcome discussion of the issues I addressed.
    http://psychology.usf.edu/faculty/data/ddiamond/rebuttal/

  2. Erin
    Durham, NC
    Reply

    I really appreciated this podcast and the points of view of both the guests and the framing of the opinions by Terry Graedon during the broadcast and in the reply above.

    In Dr. Navar’s rebuttal she says: “I wondered how many other people with recent heart attacks or strokes who are benefiting from statins heard the program and decided to stop.”
    I wonder if she actually listened to the program? Dr. Nissen made it very clear that lower LDL does reduce risk IF you’ve had a cardiovascular event, but otherwise evidence is not in place for the “worried well”.
    Dr. Diamond did a great job explaining how a Lipitor study portrayed the statistics to show a 36% risk reduction. The real difference is one fewer heart attack per 100 people.

  3. Rick
    Oregon
    Reply

    Did anyone catch the irony of Dr. Diamond questioning the expertise of Ancel Keyes because he did not have degrees in relevant areas….. and then the PhD. neuroscientist/ neurobiologist proceeds to offer advice on diet and cholesterol and other cardiovascular health issues?

  4. Adam Wachter, MD
    Durham, NC
    Reply

    Joe and Terry, and all listeners: please read the thoughtful letter to the editor published today in the Raleigh News and Observer, written by my colleague Dr Ann Marie Navar. Statins are not risk- or side effect-free medications, but it is irresponsible to broadcast inaccurate and misleading information presented by someone who does not have evidence or professional qualifications to make such claims as Dr Diamond made in this show. As Dr Navar describes, this can cause real harm by confusing or scaring patients who clearly can benefit from statins.

    http://www.newsobserver.com/opinion/op-ed/article93997317.html

    Joe and Terry, I have listened to your show for years and usually you are careful to separate evidence based recommendations from home remedies or other non-evidence based opinions, but I think in this instance you failed your listeners in this regard.

    • Terry Graedon
      Reply

      Dear Dr. Wachter, we started the show with our interview with Dr. Steve Nissen of the Cleveland Clinic. I think you would agree his credentials are stellar. We closed the interview emphasizing Dr. Nissen’s recommendation of shared decision making. We are not in any way opposed to the use of statins in people with heart disease–ie, people who need these drugs.

      You are probably aware that the use of statins for primary prevention in otherwise healthy people remains quite controversial. There are a number of studies on both sides of this topic. Dr. Rita Redberg is a cardiologist at UCSF and is editor of JAMA Internal Medicine. She has expressed a similar perspective to Dr. Nissen regarding the AHA/ACC guidelines and the use of statins, ie, that the recommendations are too broad. The idea that every man over 63 and every woman over 70 should be on a statin regardless of other factors remains unclear. Dr. Nissen made this point clearly on the show. We think people deserve to know that this remains a controversial topic and get various perspectives.

      • Adam Wachter, MD
        Durham, NC
        Reply

        Dr Nissen presented a balanced, reasonable discussion of the risks and benefits of statins and the strengths and weaknesses of risk scores and current guidelines. I have no argument with his positions or with other experts who reasonably question the efficacy of statins for primary prevention.

        Dr Diamond, on the other hand, made spurious and misleading arguments against the efficacy of statins in any setting and yet was held up as an equivalent “expert” despite not having any medical training or qualifications in this area. Not only did some of his most egregious statements go unchallenged, but many of the questions that were asked during the interview seemed expressly intended to further Dr Diamond’s agenda.

        Discussing an important topic such as statins is a worthy endeavor for The People’s Pharmacy, but it should be done in a responsible fashion with legitimate and credible experts. With all due respect, I do not feel that this goal was accomplished on this particular show.

  5. Charles
    Georgia
    Reply

    My physician has had me on two Lisinopril 20 mg with HCTZ 12.5 mg per day.
    I was taking two 25 mg atenolol per day and one 10mg Amlodipine per day.
    I have cut this medicine i only take one Lisinopril 20mg per day and i take one 25mg atenolol per day and my Amlodipine every other day this has been going on one month, this i cant believe my blood pressure has dropped down to like 110/55 and the highest 120/65 do you have an answer. My monitor that i check my bp is correct as i had it checked with a manuel checker.

  6. Mickey
    Chicago area
    Reply

    I question the extensive use of statins and the manipulation of statistics regarding the benefits of statin use. However, Dr Nissen commented that cardiovascular interventions, which I took to mean the use of bypass surgery and stents, are down some 50% in recent years, thanks to statins. How do the statin critics explain that?

  7. David
    Reply

    One more comment: Dr. Diamond did mention, besides muscle problems associated with statin use in some people, also the possibility of cognitive impairment due to statin use. For some of us that might appear more serious. I entered ‘statins and cognitive impairment’ into Google search and got the following list of sites discussing it from various perspectives (all medical science based in one way or another). I haven’t perused the sites yet, may tonight since I take Atorvastatin. My cholesterol is not high, but one of my cardiologists suggested that the statin may help inhibit the build up of arterial blockage material of which I have some, although not enough for a stent or bypass surgery. Point of information, I do have sporadic atrial fibrillation for which I also take Metoprolol, Lisinopril, and Xarelto. This is the site:

    https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=statins%20and%20cognitive%20impairment

  8. David
    Reply

    I listened to the podcast and found it interesting. Drs. Nissen and Diamond did not disagree as much as suggested. Both suggested that statins for people with no history/family history of heart disease might be unnecessary or even counter-productive vis-a-vis muscle problems, and both agreed that exercise was the single greatest aid to health. As to diet, Dr. Nissen was not as emphatic as Dr. Diamond in promoting some high cholesterol/fat foods such as cheese, eggs, butter. The so-called Mediterranean diet was recommended. Dr. Diamond particularly asserted that high cholesterol was not the culprit in heart disease and that it was in fact beneficial for older people, 70+ years. The one thing I would have been interested in hearing Dr. Diamond mention was if he thought there were any people for whom statins were recommended or advisable. The main difference to my ears was that Dr. Diamond was fairly adamant that high cholesterol was possibly good for you, not bad thus obviating the need for statins.

  9. Diane
    Charlotte
    Reply

    I have been diagnosed with blood clots in my leg- three in the right leg was put on a statin year ago, and am now realizing it was the statin….per one of you guests on Saturday.

  10. Rich
    Reply

    It’s amazing how long a notion that becomes medical dogma persists in spite of sound science proving otherwise.

    • john
      Reply

      what are you saying? There’s way more trials with supporting evidence that are pro-statin therapy.

  11. Paul
    New York
    Reply

    It is utterly reckless to have a PhD in Pyschobiology (Dr. Diamond) contradict the recommendations of the American Heart Association and the American Diabetes Association’s on the use of statins in high risk individuals. I am thoroughly disappointed you would allow an individual without the training or education to treat patients to purport himself as a Doctor and give advice regarding medical care.

    I support patient education and an open discussion with Physicians about the appropriate treatment of chronic disease. However your show may only have encouraged individuals to remain resistant to statin therapy proven to reduce morbidity and mortality. Shame on you.

    • Ed
      North Carolina
      Reply

      I understand your concern. On the other hand, Dr. Diamond makes a compelling case that the way statins have been promoted with deceptive statistics is shameful, bordering on fraudulent. You can find some Youtubes where you can see/hear more from Dr. Diamond along with some useful visuals. Alas, medicine/pharma/nutrition have been extremely hidebound in some important areas, and I think it is reasonable to give a hearing to people even if they are not optimally credentialed in the precise field that they are talking about. Anybody familiar with the sad history of nutritional recommendations from all the suits should appreciate the urgent need for fresh perspectives. There is a lot of corrupting corporate interests among other issues. But, yes, I understand your issue and always approach information from outside the establishment with caution.

  12. Gary
    Seattle
    Reply

    “The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast.”

    Great, When?

    • Terry Graedon
      Reply

      The podcast will become available starting tomorrow, July 31, 2016.

    • Tony
      UK
      Reply

      Gary echoes solid and well thought-out conclusions based on an unbiased reading of research. On the other hand, Dr. Diamond professes to be unbiased, but when he mentions the French paradox, he demonstrates his shallow research in this matter of cholesterol. Your gentle readers and listeners who would like to broaden their knowledge would greatly profit by listening to `Plant Positive.`

    • Lisa
      Los Angeles
      Reply

      Sorry but I don’t agree with you. It is well known that the AHA and the AMA are loaded with conflicts of interest and there has for many years been a bias toward the pharmaceutical industry. The ADA is also one to be careful of. My dentists used to praise amalgam fillings long after many countries banned them. Now my dentist wouldn’t put one in anyone’s mouth even if they begged for one.

      I have friends who are doctors and they don’t buy everything the AMA is selling.

  13. Carlos
    Greenville, SC
    Reply

    I was in the hospital in 2009, post brain surgery. During recovery, I was put on a statin. I felt horrible. I was tired all the time and felt like I had a weight on my chest. Breathing felt like it required conscious effort. I quit taking it, after a friend reported similar problems and quit taking hers, and immediately felt much better. I have another friend who stayed on his and is now suffering from lewy body dementia. His mind nearly gone.

  14. David
    Wausau, WI
    Reply

    Just a question. When is the podcast on statins with Dr. Nissen and Dr. Diamond?

    Thanks,
    Dave

    • Diana
      Calif.
      Reply

      Would very much enjoy viewing the Podcast. It says we have until Monday, but how to we access it?

    • Terry Graedon
      Reply

      The podcast will become available starting tomorrow.

    • Barbara
      Portland Oregon
      Reply

      David my husband took statins for four years following his heart surgery, and he is now suffering from Lewy Body Dementia. I wonder if this could this a long-term side effect. Now I’m wondering about his Metoprolol and Lisinopril.

      • john
        Reply

        or genetics?

  15. Mark
    Miami
    Reply

    I must be missing something because I see all of this information regarding a Podcast on a very important matter, yet there is no date, time or other information on the broadcast date. Looks like a way to sell a CD instead of providing valuable information. And someone gave this a 5 star rating. Go figure.

    • Terry Graedon
      Reply

      Sorry I missed a step in posting this notice. It is up now. The broadcast aired today (July 30, 2016), but some stations will run it later, according to their schedule.

      The podcast will become available starting tomorrow.

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